EMR Interviews

Mark Anderson talks about the Continuity of Care Document (CCD) standard

2009-05-13T11:19:00Z

Mark Anderson of the AC Group, Inc. and Robert Gleeman talk about the CCD standard. Click the Play button to watch this interview.

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This is a transcript of the above interview.

Robert Gleeman: This is Robert Gleeman with EMR Update. I'm talking on Casual Friday with Mark Anderson from the AC Group. Mark, thanks for being with me again, today.

Mark Anderson: Well, thanks for giving me a call, here. It's been awhile since we've talked, and there's a lot of things going on since that news conference.

Robert: There are many things going on in response to the stimulus bill, and you have some specifics that a person should be mindful of when buying an EMR. You mentioned to me in an email that one of the main points that you've been talking about is the requirement to be connected to a community HIE. What is a community HIE, Mark?

Mark: Well, basically, there are three provisions underneath the stimulus act, the high‑tech act. Obviously, one is certification; one's reporting data. The second one, really, was being able to be connected to a connected to a community health information exchange.

The goal of the high‑tech act is to get rid of silos of information and getting all of the doctors connected together. So, an HIE really allows doctors on separate EMR applications to share clinical information about the patients. The data is collected once, but all of the doctors in the community who are treating the patient have access to that information.

Robert: So, it seems to all be about connectivity. You mentioned also in your email that the connectivity goal is PHR, public health record. We've been hearing about the Google public health record. Is that the same thing? Or is that a personal health record?

Mark: Well again, what the government is talking about is getting all of the information from all of the different providers that are treating a certain patient. So, the patient has access to that information. Most people are calling that a personal health record, one place the patient can go to learn everything about themselves. Then they can take that information to another provider in a different city or different state, or at least allow the doctor access to that information.

Now, there's Google Health, and you also have Microsoft Health involved. These are kind of like those products. They allow the patient to enter information. But what we really have to have is the provider information updating into a location, along with the patient able to put their health‑related information in. We need data from all sources, so there is truly one personal health record for that patient, no matter which provider they go to.

Robert: Are you finding that the patient wants to be involved in this record‑keeping process? Are they cooperative?

Mark: Well, I think it's just beginning today. Kind of look at it as when a patient shows up in a doctor's office, the doctor asks the patient to fill out a number of forms dealing with their social history, the medical history, the family history, what medications you've been on and what other doctors have you seen. So they're already asking the patient to fill out information, but it's done paper.

This way, the patient goes online, fills out the information one time. And no matter which provider they go to, that doctor has that information. So yeah, the patients are getting involved. The surveys have shown that about 68 percent of all patients that have been surveyed would prefer to fill information out before they showed up in a doctor's office.

Robert: So you're saying, as a prerequisite to get these high‑tech funds from this stimulus bill, you really need to look at connectivity. How are you supposed to know about how connective this EMR product is? Should you go by CCHIT?

Mark: Well, that's a good helping point. CCHIT, based on the 2008 standard, requires vendors to be interoperable. What they're saying is that you have to be able to send a document, like a fax. In the 2009 standard, we believe that they are also going to build in data exchange, discrete data exchange following the continuity of care document infrastructure, CCD. This is the combination of the CCR standard plus the HLSMA [sp] standard. So, basically CCR plus CCDA is the patient care document standard.

We believe that to get the stimulus package you're going to have to exchange data with all providers in the area. Right now, the CCD standard seems to be where everybody is moving towards. You have to be CCD compliant before the doctor will be able to get access to the stimulus money.

Robert: Now, you said that you're talking about this a lot. Is that what you're doing right now? You're in Atlanta, Georgia, as I understand it.

Mark: Yeah, we're finding that there are probably about 100 of these projects that have been going on across the country. We used to know them as RIOS. We kind of joke around that RIOS didn't work because there were four initials. You really need three initials for everything in healthcare. But there are a lot of projects going on that are called HIE informations. What a lot of them are doing today is exchanging information between the hospital and the doctor, or between the LabCorp/Quest and the doctor.

In the future, we're going to be exchanging data between the primary care doctor, sending information to the cardiologist, who may send them onto the GI doctor. All that information may get summarized to go to the emergency room doctors, so they can get access to information about the patient.

The nice thing about this is you don't have to be using an EMR to get access to summary information. If you're a physician that's on paper ‑ there are paper‑based charts today ‑ when a patient checks in, basically a clerical person, or the nurse, could go online, find that patient's record, print it out and stick it on the chart for that physician. That will have on it what medications the patient's on, what laboratory results, which doctors they've seen, what health maintenance alerts are they behind on, what chronic diseases do they have.

It's going to have a wealth of information about the patient in a common format, the same format no matter where you go in the United States. That same printout will come out no matter where you go. That's the advantage of having one kind of standard for sharing information.

Robert: What you're saying is that the standard has been selected, and it is CCD.

Mark: From all indications we've seen, yes, the CCD is the standard moving forward. But again, it's really only capturing summary information about the patient. When you ask doctors what they want, about 90 percent of what they really need is in the summary document. It's not capturing everything. It doesn't capture the complete medical record, but it captures the information that the doctors traditionally want to pass on to another. So, yeah, it's very strong for the doctors' needs to understand how to treat the patient today.

It's a great starting point. Ten years from now, we'll have something different probably. But it is the starting point moving forward.

Robert: Does anyone, right now, have CCD compatibility?

Mark: There are about 30 EMR vendors that we've tracked right now of the 400 that have the capability of producing a CCD report and then passing it on to another there. What we don't see today, [inaudible 8:34] another EMR vendor and it's not really working. They're essentially in the sandbox.

The way it's been working is that EMR Vendor No. 1, will send information up to the HIE, a community portal offered by potentially another company. Then that information is sent down to the EMR Vendor No. 2. So typically what you see is some pretty good EMR vendors that can exchange the data and what they portal in between that information can be exchanged.

And we think that's probably the best model because rarely are you going to get every single doctor in the community using the exact same EMR. And I like to have a vendor‑neutral HIE sitting on top.

Now, if every doctor in this community has one EMR vendor, then it makes sense. You can just have one thing. But I think we're going to have a lot of communities where multiple EMR vendors are going to win out, probably all the specialties. We need that neutral community vendor to tie everything together going forward.

And, again, that's what's going to be required to meet the stimulus money. Remember, the goal of the stimulus in high tech, is to eliminate silos of information.

Robert: And a silo of information would be for instance, what?

Mark: Any doctor who has an EMR in their office that's not connected with anybody else, is really a silo. A doctor that has paper charts that's not connected to anybody else is a silo of information. We want to find out that Hayden had a lab report and you're a treating physician, you want to get access to that report, at least be able to read it.

We know that that helps reduce the duplicate paid entry by about 72%. It's also proven to eliminate a lot of duplicate tests. It's going to help save costs, it's going to help provide much better heath care because now we have real information about the patient at the point of care.

How about that patient showing up at the emergency room? Right now you show up there, the ER doctor knows nothing about you. Now, the EMR doctor's going to have a history of what's going on with you, which physicians you've seen, what medications you have had, if you have had heart problems in the past, if you're a diabetic. That information will be available to another physician in a nice printed a copy and they don't have to go on the computer to look at it. We can just print it out and stick it on front of the chart, just like most doctors want. I want a summary page on the front of the chart so I know the patient, I don't have to collect data myself.

Robert: Is this what you're talking about over there in Atlanta?

Mark: Yes, I've actually given four speeches this week alone on the subject, "Creating the Community EHR, " basically, a community EHR. I kind of call it a Grady Community EHR, we kind of joke around, are you ready for the ice age, the ice age is coming. So, what we're looking at is how can a group of physicians in a community pick different EMRs but still be able to share the information no matter where the patient goes. So, we're doing a lot of talks on it and probably about 80% of the calls I've been getting on our consulting business is how to set up a community integrated EHR with multiple EMR products.

Robert: Would you say that it's possible for a non‑CCHIT certified EMR to be CCG compatible?

Mark: Yes, there are a few of the vendors that we know do know about who have not gone through CCHIT certification, but they can generate a CCD record. They already can prove inner wrapper ability. They just haven't gone through in doing everything for somebody. It works really good for some of the specialties, for the dermatology, for the orthopedic doctors, so they don't need to collect everything that's been on the CCHIT requirements.

But again, I think if we can provide the right information at the right time, to the right caregiver, that's what we really need.

Now, CCHIT I think is a good starting point, but there are a number of vendors that [inaudible] CCD data exchange that have not come through the process of getting CCHIT certified. Or if they were certified, it would only be on 2006. The real determining point is going to be is what is the final decision on when to the product has to be certified to meet the High‑Tech Act so the doctors can get the money. Does that mean they have to be CCHIT 2010 or 2009 certified? Or if they only have to be certified that they can exchange data following a common format like CCD. No one really knows yet.

Robert Well, that's one question that comes up a lot in EMR update in the forum, is that there are so called anti‑CCHIT sentiments. That there's some very good small vendors who could never afford the $36, 000 or whatever they charge, is there any talk or any hope do you think, of that going down, so that a small vendor could afford it?

Mark: That's a good question. Now that the CCHIT Office is going to be given $2 billion to create a lot of these standards, to me it would seem if they've got $2 billion they might not have to charge that much to go the standard process. They've got the money to pay for it.

Remember, when CCHIT go set up, they were only given a $5 million grant. Now, they've got $2 billion. Now, obviously, they're not going to allocate all of it, but they could allocate some of that money and bring that cost down.

The challenge ends up being, do every single specialty really need a full CCHIT server to find product or do they need the CCHIT requirements. Because every specialty doesn't need everything that's in there. And a lot of the vendors are getting [garbled], they're also going after pediatrics, the cardiology and, in the future, OB‑GYN, and dermatology and orthopedics. They're going to create standards for all of these.

I think it's a good point to have but we've got to go back and what is the reality? We need to share common data. You have to be CCHIT certified to share common data. We'll have to see what the government comes out with. They may require it.

Robert: Well, someone once said that the greatest accomplishment of technology has been connectivity, that it is the thing, the single‑most, society changing advancement in technology. And you are bearing that out in what you're saying about the EHR, the EMR, the personal health record. It all seems to come together into that concept of connectivity.

Mark: Right.

Robert: And that is exactly what you do not have with paper records.

Mark: And even standalone EMRs were not connected. Think of another three letter initial, ATMs. I can go to any bank ATM machine now, put my little card in and get access to my money and bank. It doesn't matter which bank I'm connected to, the ATMs all connect everybody. We need the same type of health care ATM and we're calling those Healthcare Information Exchanges, HIEs.

Robert: That's the best analogy I've heard all day, Mark. I think it's a good place to end until our next meeting.

Mark: And I'll see you next Friday.

Robert: Let's do that. We've had a few sound problems, but I think we've got it all down.

This is Mark Anderson with the AC Group. Mark, I want to give your cell phone number, as I often do, (281) 413‑5572, if you want to call Mark Anderson. And, Mark, thank you very much for being with me on "Casual Friday." It looks like I'm the more casual of the two today, but we have matching shirts.

Mark: OK, talk to you later.

Robert: Bye, bye.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here and other EMR Interviews here.

Mark R. Anderson CPHIMS, FHIMSS
CEO and Healthcare IT Futurist
AC Group, Inc.
118 Lyndsey Drive
Montgomery, TX 77316
(c) 281-413-5572
(f) 832-550-2338
email: mra@acgroup.org
web: www.acgroup.org

Mark Anderson of the AC Group on the Obama Stimulus Package

2009-03-16T17:37:26Z

I recently spoke with Mark Anderson via ooVoo video interview regarding the Obama plans for Health IT, and he had some interesting things to say about data entry collaboration.

Press the arrow below to play our video interview and feel free to comment here.

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To contact Mark Anderson:

Mark R. Anderson, FHIMSS, CPHIMS

CEO, AC Group, Inc.

Cell: 281-413-5572

mra@acgroup.org

CHR: A black-box description of Community Health Records

2008-12-24T10:37:00Z

Robert Gleeman talks with Mark Anderson of the AC Group about what's going on in the world of community health records.

Click the link below button to watch our interview. (a technical issue - I cannot browse to the media item)

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This is the transcript of our interview.

Robert Gleeman: This is Robert Gleeman with EMR Update. I'm talking today, on Casual Friday, with Mr. Mark Anderson from the AC Group. Mark, thank you for being here with me, and have a happy holiday in case I forget to mention it.

Mark Anderson: Same to you! It's been a while since we've done one of these.

Robert: Yes it has! And I was hoping today you could get me caught up on what's going on in the world of community health records. Or, as we have dubbed it, CHR, as opposed to EHR. In the community, can you give me a black box description of what we're talking about, so we can fill everybody in on what is a CHR?

Mark: Well, really a CHR is a combination of local practices' EHRs. The ability to do data exchange between a family physician, an orthopedic practice or cardiology practice, using either one EMR or multiple EMRs, where the practices, because they're independent, want to maintain separate databases of their practice management and EHR data for their patients.

Robert: But this isn't a normal EHR. You need a special type of program for this, don't you?

Mark: What you have to have is some strong EHRs with interoperability capability, like has been established in the 2008 CCHIT requirements. And then you have to have something that sits on top of it that does the electronic health exchange between the two of them, the different products that are out there. So the information from one EHR vendor flows up through some kind of separate product that captures the data and then can send it back down into a separate product. Basically following the old company pair record, now CCD standard, for data exchange for demographic and clinical information.

Robert: So, essentially everybody has their own database, every doctor's office, every hospital, every community health clinic. Is that right?

Mark: Yes. Now, they all have their separate databases. Now, if a clinic is owned by a hospital, it may be part of the hospital's database. But a lot of individual practices put separate EHRs and separate databases to still do data exchange. When the patient goes from one practice, and is referred to another practice, we can actually move over the clinical information. The nice thing about it, too, it has a community master patient index. If the patient has never been seen by me in the past, I can actually go into the system, look up the patient, find up their name, address, and chart information, and then download it directly into my separate practice management system so that I don't have to do the data entry work.

Plus, if somebody changes their address, everybody gets the address updated at the same time that's treating that patient.

Robert: So in order to set up a system like this, do they all have to be on the same brand of software?

Mark: No, right now they could be on different EHR products and different practice management systems, as long as they can meet the interoperability requirements that are out there. Again, the old CCR, or CZA, or CTD (they have so many three initials now), but basically the community data exchange requirements. So, you can have any system you want as long as you can exchange data meeting those requirements.

Robert: And can you give us some brand names of software that people are using to do this. I know that one of them is eCW, eClinicalWorks, because we've seen the press releases. Can you name a few more?

Mark: They're interesting right now, because if you look at the vendors that really are in this community data exchange model, you've got some of the traditional vendors, Axolotl, Healthvision, Wellogic. (We'll have to cut that little bit out, restart that part over again.) {Nick: ah, can't edit our FLV so we've included these impromptu moments}

Robert: OK.

Mark: I think of another member, RelayHealth. OK.

Robert: RelayHealth.

Mark: There are vendors like Health Logic. Forget that one. There are vendors like Wellogic, Axolotl, Healthvision, and Relay Health that are providing the community data exchange. Now we also have vendors like NextGen and eClinicalWorks that are providing a community portal that, in theory, can exchange data between multiple vendors. We think by probably first quarter of 2009 Allscripts, with the MyConnect product, whatever we're going to relabel it, will also be able to do that. There are also some things like Noteworthy that are able to do these community‑based systems today. We believe GE can also do that. We're kind of looking at who has press releases of this today.

Robert: Last time we talked about community EHR or CHR, you gave me the impression that a doctor should wait for this community action to take place and then join it. Do you still feel that way, or can a doctor or an individual, a one‑man practice, start this and get into it on his own?

Mark: I think there's two ways of looking at it. There's no reason to wait for a physician to say, "Hey, I'm going to wait for the community to be built." Because as long as your product is interoperable, meeting the standards, you should really get whatever product you want to connect into it. The difference is going to be, because of the change in the Stark law, the hospital may only allow a few vendors to get connected in the beginning because of the cost of the connection and everything.

So some of the doctors are waiting for the community to be built, and then going with whatever product the hospital, the IP [?], or the MSO is recommending because they can subsidize some of the cost.

So the question is, do you go with the product on the one that you hope will be connected, or do you wait to go with the product that a community might be putting together that's also subsidizing the cost.

What we're finding is about 70 percent of the small practices are putting off their decision, partly because of all of the confusion in the EMR marketplace, partly because of the economy right now.

And a high number of them are saying, "I'm going to wait to see what our community builds, because they're talking about it today." But you've got to get the right product to meet everybody in the community's requirements.

Robert: You mentioned the CCHIT recently made some specifications for a community system. And this is fairly new. I believe you said in just last year, these specs came out?

Mark: Well the 2008 CCHIT requirements really talked about interoperability, which is a foundation for building these community systems. Remember, the CCHIT 2008 standard only came out in July of 2008. And it's going to go all the way through June 30th of 2009. We have some vendors that have documented that they could do interoperability, besides other things that are in the CCHIT requirements. But just because a vendor's not on the list yet does not mean they cannot do it.

Again, they've only gone through one round of testing, and I believe another round of vendors will be announced either sometime this month or early in January of 2009.

Robert: Now this brings up a point that we argued about in the EMR forum. Is CCHIT going to survive the new administration? What is your opinion on that, Mark?

Mark: The interesting part, like I say, I believe the initial government funding is now up and that the CCHIT has to survive on its own going forward. And the question's really going to be, is do they have enough vendors willing to pay the fee to get certified? If you start looking at the numbers, remember we had 90 the first year, 50 the second year, and we have 10 so far this year. But a number of the vendors have not been certified yet.

Of course, they've added new categories. Now you can also be certified on the cardiology‑specific, pediatrics, I know they're working on mental health. They're also working on a personal health record certification. What they're doing is adding additional categories so they can get more certification plus more revenue coming in.

But it will be interesting to see if they have enough vendors willing to pay the fee to get certified going forward. You got to remember if you're not certified then hospitals are not allowed to really subsidize the cost of a product, the same with the MSOs, PHOs, and IPAs.

Right now it still requires a certified product within the last twelve months. Of course, a designate has to be CCHIT certified. Right now that's the only government certified agency that is providing any kind of certification. So it's the lack of requirement going forward.

Robert: Do you feel that President Obama will be supportive of this community health record concept?

Mark: Well let's look at the foundation for all of it and why are we even looking at community. And the whole idea was creating these RHIOs in the beginning. Sharing of data between multiple societies and groups that are out there probably sounded good. But from the research that has been done by Hens and other groups we found that most of the RHIOs did not survive because they were not having enough financial liability to go through. There' a few of them going on out there but most of them have not survived at all. So think of the models of these EHRs and it requires a lot of data entry by the physician. The patient has to fill out his social history, medical history, family history, view assistant, HPIs and everything else.

Why can't we just do it once? Why can't we have the patient filling out the information for the first time when they see the primary care doctor and then all of that information flows directly into the cardiologist, the orthopedic surgeon, the neurologist, the dermatologist and we save all that data entry time?

We can cut out about 70 percent of the traditional data entry if we share all of that information plus lab results and pharmacy medication the patient is on, diagnostic procedures. Because one of the problems with EHR has been that we have to get data into these systems.

We've got five years clinical data on a patient on paper but how do we get that information into an EMR and if a patient is going to five different doctors we have to enter it five times. Look at the chance of mistakes. On a community base system we enter it once and it populates multiple EMR products.

Now one of the questions that always pops up why would a hospital want to subsidize the building of these community base systems argument of it being obviously physician bonding. If we could connect all of this information together what would doctors like to work with our hospital?

But there's a real reason behind most these community based systems from the research we have done. And it's that for every 20,000 emergency room visits within a community we figured out the hospital can save about a half a million dollars in uncompensated emergency room care.

Because if the emergency room doctors have the information on the patient they know the name, address, their social, family and medical history, what procedures they've had, what lab results, what medications they're on, what their allergies are that gives them a wealth of information.

And the emergency rooms doctors have said if we have all that information about the patient we can get them in and treat it quicker and improve the quality of care within the emergency room much better if I had that information as a lot of duplicate test are run because we don't know enough about the patient.

And a lot of emergency room care is uncompensated or if the patient goes from the emergency room and gets admitted like a Medicare patient all of that emergency room cost is rolled into the in‑patient DRG.

So if we can have information about the patient at the bedside for the emergency room doctors on average we've shown that we can save about half a million dollars for every 20,000 ER visits today.

That pays for a community based DHR in most smaller and larger communities out there.

It's a win for everyone. We get better patient quality; we get a community based system where doctors can pick what EMR practice management system they want as long as it meets the standards.

And we're creating interoperability. This is kind of a model that they originally talked about with the RHIOS but we weren't able to connect everybody together allowing them to use their own EMR's. I think this is the future of health care and it's going to solve some of the problems dealing with cost and the major problem of getting all the data into the EMR.

Robert: You've used the term RHIO how are you spelling it and what do you mean by it?

Mark: Well the whole conversation that Brailer came up with a couple years ago was RHIOS, Regional Health Information Organization which is a way of sharing data between communities. The problem is there was no data to be shared in a lot of these communities, because most of the political businesses are paper based. We can share some demographics. They had a little bit of lab, but we really need to get the information from different practices. So the local joke always was back in the 90s we had CHIM, C‑H‑I‑M, then we had RHIO, R‑H‑I‑O, now it's because it was four initials. We need to go back to three initials on everything.

So HENS are talking about HIEs now, Healthcare Information Exchanges, you know we have EMRs, we've got EHRs, we've got PMS for Practice Management System let's create another three letters, CHR for Community Health Record. It's really a community electronic health record, electronic medical record, data exchange, EHI combining everything together to really get the benefits that people are looking for.

And I think if you go back and talk to Obama and his organization and everybody else this is what they've been talking about for a while but no one's really come up with the right model to make it work.

This is the model that would work for everybody. Financially sustainable for a community to do these and there's a number of small rural communities trying it today. And I think they're going to be very successful.

Robert: As a consultant where do you come in, Mark? Who calls you? What do you do? I'm curious.

Mark: Well we're getting a lot of calls obviously from regular physicians looking for systems or they're telling us that hey, I heard that the hospitals trying to do something. We just did a speaking engagement down in Florida where about 300 doctors were looking for an EMR and I approached them with this idea of creating a community based system around the hospital.

And it happens to be two local hospitals that kind of compete in that community. And I said, well, the physicians need to get together and say we need to build a community project, a community electronic medical system. Maybe get both hospitals involved in this and make it work for everybody.

So in this case I think we've got the physicians saying, hey, we're really encouraged about this, this sounds like a great idea. Now the physicians and hospitals have invited me back down in January to really talk about what is the model for a community health record? What's the benefit?

They need to hear about this. So we provide a lot of educational things, speeches, and hopefully someday in the future they'll decide they want to move forward and, ideally, for us or some of the other large nice big consulting groups like the Cofa Group or the AC Group we can go in there and help them determine who the right vendors are for them, maybe have one or two EMR vendors for the community building the community health record on top of it.

And the thing we really like doing is negotiating those contracts with those vendors. That's the part that really gets fun for me.

Robert: And when you say negotiating with the vendors are you usually working on behalf of the individual doctors or the hospitals or both?

Mark: Well, actually both because in this kind of model you're building a community based system through negotiating for whoever's kind of running or champion for the community. And then you're also negotiating for the individual doctors, because they may be picking different products. So you'll have a community that sits on top, a community system, you'll have individual contracts for each one of the physicians. And the goal is to really help everybody, because you have to admit if you look at those contracts from the vendors, right now they're there to protect the vendors. There's not a lot of protection for the community or the physician.

On average we've come up with about 60 to 90 changes in the contract term and service log agreement. And on most cases we've been able to save two to nine times our total cost. Just in the cost the vendors are charging the doctors. Especially is you're coming together as a community, you know two individual doctors give one pricing. So if I could bring eighty practices together we're going to get much better pricing for the whole community.

Again, coming together as a group, you're going to get much better pricing, much better support, much better ways of rolling these products out.

If we can get physicians to agree to champion the development of a community‑based system... Maybe we get the hospitals, the MSO, the IPA, or the PHO, to help fund this, or at least, another champion to keep it going.

Robert: What would you suggest to a doctor that wants to be involved in this, but there is no hospital program? Is this something that one person can initiate and start, or does it take a hospital to start it?

Mark: Actually, it takes a vision. There's a doctor that's up in London, Ohio, that has said, "I want to create a community‑based system. It's a one‑doctor. He's a pediatrician, but he has been the force for driving this whole community‑based project that's going on up there. There are little ideas that really try to build this community‑based, electronic health record, but his model's even bigger. He wants to tie the hospitals and all the physicians in the community together, along with home health, long‑term care, the local pharmacies, tie the 911 service into it, the police, the fire department. He wants to tie it all together, so all information about anybody who lives in that community, with the right security and HIPAA requirements, is out there.

In the case that the ambulance goes out and picks up somebody that happens to have a car accident, we're able to identify who that patient is. We know information about them, and that could be directed directly to the emergency room for better care, improved quality, and reduced costs.

In this case, one doctor, Dr. Alexander, has created a push for creating a community‑based system up in Ohio. All it takes is one doctor who wants to champion these things.

Then again, you have to be able to roll it all together, bring all the doctors together, and bring the hospitals together, into an overall view of how they want to do it. They're going to be rolling this out in the next year: a community‑based system for about 30 doctors, at a 100‑bed hospital, in a nice, rural setting.

I've got a couple of other communities doing the same thing. Spencer Hospital, up in Spencer, Iowa; same type of thing. They have about 25 doctors, and the hospital, all coming together to build a community‑based system. They're putting a community portal on top, with one personal health record, and electronic health records, the practice management systems, for all the physicians in the community.

It makes sense. It's going to save money, and probably is going to improve the overall quality of health care within that community.

Robert: When you say they're coming together, people don't just come together. Somebody has to bring them together. Is that part of what you do as a consultant is set up meetings, have this person talk to that person and set them on a path? Is that part of it?

Mark: Yeah, typically, we get somebody who's interested in this, and we set up what we call an educational session. On the evenings, we bring some doctors, we bring some of the hospital people together, and the other people in the community that also take care of the patients' health out there today. We bring them together and we talk about the potential out there. We talk about the benefits, what it's going to take, talk about the costs. It's amazing, when you get a community of people together. They have a lot of questions, but they come out of an educational session, and they're like, "This would work. This makes sense for all of us."

That's what we just need, a doctor who says, "Hey, I want to create this. I want to set up a meeting." Or a hospital, a CEO, or CIO, or CFO, who says, "This is a show. Why don't we bring everybody together just to talk about it?" Bring that community together to look at business, political, and health benefits for their whole community. It doesn't take a lot to do that.

Robert: One time, you told me... I remember what people tell me, even though I don't remember my own phone number sometimes. This was comprising about 90 percent of your business at this time, which seems like a huge amount. Is that still the case, Mark?

Mark: Yeah. We're still helping out a lot of the smaller practices, to the medical societies. Some of the dockets are still going out for the ones‑ and two‑doctors. But, really, the majority of our travel business... When I have to travel, it seems to be more involved in larger communities coming together where there's a hospital involved, and one or two practices. I'm doing a project in Ontario, California, right now, with an IPA, that has 300 primary care doctors, and about 1,500 specialists, trying to build a community system for there. We're seeing a lot more of the capital roll‑out, community roll‑outs, with different names and positionings of it, but it's all about: how do we find a way of sharing data in the community, to cut down on the duplicate data entry that is required for electronic health records.

That's why I think a lot of these systems have failed out there. There's a lot of EHR failures out there because it takes too much time to get all of the old data into the computer system to make it effective for the physician to use.

We've got to find a way of populating all these EHRs. Our philosophy is: populate it once, and populate many of the EHRs at one time. As long as the physician is treating that patient, why can't we just share the data? That's more of a community‑based system.

Buying standalone EHRs out there doesn't really help a lot of practices, because they don't have the time to do all the data entry to get the information in there. If the EMR is effective, to be able to look at the prior visit, look at health maintenance over a period of time, I have to have all the data in there. A community‑based system can do that for you today.

Robert: Finally, I wanted to ask you: is there a convergence going on between EMR and EHR? And is that what community health records represent? This convergence?

Mark: Yeah, we're seeing that most of the EMR vendors, now, are able to track health‑related information, the health maintenance alerts, and things like that. Almost all of them now either have their own personal health records, or they're working with one of the personal health record products that are out there. Of course, everybody's been talking about health malls, and some other things, the Microsoft, Google type settings. But I think we're moving toward a point where certain health‑related information is required out there, for the primary care, the pediatrician, the internal medicine, and the ob‑gyn.

You find a lot of other doctors are saying, "Look, I'm just treating this one problem, a sprained ankle, or a rash on an arm. I don't absolutely need to put all that information in, but if the data is available, I like to have that." I think what we're going to have is a combination of medical information, and health‑related information, brought together within the whole community.

But, again, why don't we have one person entering it? The patient, the nurse, or the physician, entering it, and then it populating through all of the other caregivers that are treating that same patient over time, getting all that to the emergency room doctor, when the patient has to go to the emergency room for whatever reason, that that data flows directly to them, so that we're sharing the right information, at the right time, at the right place, with the right caregiver.

Robert: We're going to put your cell phone number at the end of this interview, Mark. Would you recommend people give you a call if they're becoming involved in the community health records situation, and get the lay of the land?

Mark: Yeah, we take calls from all kind of people that are looking for things. We just say, "Look, if you're interested in this, if you want to have more information about it, what is your hospital doing, how to approach the hospital to get this stuff going..." We, basically, say, "Get on the phone. Give me a call." My cell phone is 281‑413‑5572. You don't have to apologize because you got my cell phone. I travel four or five days a week, and that's the best way to get a hold of me. Or you can just email me any questions you might have, at mra@acgroup.org.

Robert: Mark, that's great. Again, I want to thank you for being with me on Casual Friday, and give you my best wishes for a happy holiday for you and your family. And also for all of our listeners and watchers out there in EMR Update land, happy holidays to you. Thanks again, Mark.

Mark: Happy holidays for everybody that's in the EMR Update, and keep reading and keep looking at these great webcasts and videocasts that we're doing. Thank you.

Robert: Thanks again, Mark. Have a great day.

Mark: Right.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.

Robert Gleeman chats with emrupdate Sponsor, David Dickson, President of TSI Healthcare

2008-11-03T08:10:00Z

This is a transcript and audio interview by Robert Gleeman of emrupdate.com with David Dickson, President of TSI Healthcare, Inc. in Chapel Hill, North Carolina. TSI Healthcasre is a value added reseller providing EMR solutions from a number of different vendors supporting NC and the Doctor's practices across the East coast. TSI Healthcare are also a proud Industry Sponsor of emrupdate.com.

Click the play button below to listen to our interview

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This is the transcription from our interview:

Robert Gleeman: This is Robert Gleeman with EMR Update. I'm talking today with David Dickson, President of TSI Healthcare in Chapel Hill, North Carolina. Thank you for being with me today, David.

David Dickson: Thank you for having me.

Robert: David, I understand that TSI Healthcare is a value added reseller, a VAR. Is that correct?

David: That's correct, yes it is.

Robert: Now, most VARs sell only one brand of medical software, but you don't. You sell several different types of software, don't you?

David: That is correct as well. We represent several product lines, and several different areas, both product‑wise and territorially.

Robert: Although you're located in North Carolina, you work all up and down the East Coast, don't you?

David: We do. Primarily, though, we are concentrated most heavily in the Southeast and Mid‑Atlantic regions.

Robert: One thing that I noticed from looking at your material is that you are very service‑oriented, and you have a philosophy. If I can sum it up, it is that the philosophy is that if you don't fully utilize the EMR it can be disruptive. Can you tell us how that can be?

David: Well, I would say your summary is right on target. In particular, I think there are a number of good products that are out there that are what I would refer to as a mousetrap, in that you can have a super product, but if it's not implemented correctly and fully, and it's not implemented with a commitment to results, then you end up with just another piece of software that will sit unutilized, undervalued, and overpriced.

Robert: How do you go about doing this? What is your approach to implementation and training?

David: I think that there are philosophical issues at hand first, before the implementation process begins. When I refer to philosophical issues, I'm referring to a commitment at the front line all the way to the back line that we're not just selling systems, and implementation plans for practice management or EMR.

Anyone can sell a computer system, and anyone can get out there in the market today and sell practice management or EMR. The commitment to making it work for that client, we consider a responsibility to them, and so when someone comes on board with us, they have our commitment that we're going to take whatever that product is that we've recommended for them, and implement it to its highest possible utilization.

Robert: Now this is a dedication and a passion towards the full utilization of the product. Do you sell the hardware as well as the software?

David: We do. We are a one‑stop shop for any practice that has those needs. Most of our client base is in the five to 15 doctor range, and do not have the resources to have their own IT departments, nor the expertise necessary, in most cases, to ensure that what they're getting is compatible with either what they have or what they're going to be getting. So we do provide assistance in that area.

It's not a revenue income area for us, but merely another convenience that we pass on to our clients, should they have those needs. We also house a very, very robust application services provider system in‑house for clients today where most of our clients in the last few years, in fact all but one, have gone on our ASP system rather than putting in‑house servers in the practice.

Robert: Why do you suppose that is? Why is the ASP side getting stronger?

David: That's an interesting question as well. I've been in the business now for 26 years, and I had always believed that having your data in‑house was an advantage, because that's what I grew up in. So when we looked into the ASP business a couple of years ago, I was very much against that liability on our end, because mostly I did not understand the technology and the backup mechanisms that are in place to provide complete protection for the clients, that would then become our responsibility.

We actually purchased a company about three years ago, that owned their own ASP, so all of the sudden we were in the ASP business, and I grabbed onto the walls and sat back waiting for the worst to happen. The realization over time that, for instance, in the first two years we had a total downtime of less than 15 minutes that was unscheduled.

As more and more practices ‑ and this is to answer your question ‑ are implementing, or attempting to implement electronic medical records, no longer is it acceptable to come in on a Monday morning and find out that your power went off over the weekend, that your servers are down, or your ability to send claims is not able to be dealt with immediately. Those are the kinds of questions that typically can wait for a support person to call back. But when a doctor comes in on Monday morning at 8:00 or 9:00, or is trying to dispense a medication or prescription refill over a weekend, and he or she cannot access that server for the patient's chart, you've got a whole 'nother ball game.

So with that said, the fact that our ASP environment provides a 24/7 monitor on the equipment, on the data, every line and character of data is backed up and backed up and backed up again to ensure ourselves, not only against routine down‑time, but natural disasters, which we have seen, obviously, affect health care around the country, particularly in the Gulf areas. So, that sort of paranoia has driven us to a whole 'nother level of providing ASP services for our clients.

Robert Gleeman: And you actually provide the ASP servers? You run the center, itself?

David: We sure do.

Robert: So, with that much control over the system, does this help you in training and bringing people up to speed?

David: Well, to answer your question again, yes it does. And, once again, years ago when people were running off of an AIX or Unix box, you had the manufacturer of the equipment and the originating authors of the software. You had two people to point a finger at. Introduce the Internet, Microsoft Windows, Citrix, Terminal Services, Microsoft Sequel, application software, all the EDI services that are now available, and nobody knows who to point a finger at anymore. This is one more level of ‑‑ again ‑‑ single source provision that we can offer to our clients that they're not pointing, is it hardware or is it software? Once again, that ball is in our lap to resolve regardless of what that issue is.

And most of the people out there in our business do not have that luxury. They farm it out to someone else and you've got a hardware company pointing at the software people, the software people pointing at the hardware people, and meanwhile, the client is in the middle with a down system. And this does happen.

Robert: So, with TSI Healthcare, you only have one neck to choke. Is that what you're saying? [laughs]

David: That's what we're saying. One head to grab by the hair.

Robert: [laughs]

David: We make two promises to our clients, and it's the same two promises that I've made since I've been in the business and working for my father many years ago in this business. The first promise we make [to] any client is that they are going to have problems. The second problem, on top of that and equally important, is that they will not regret their decision to do business with us. We're not just selling systems to every physician that wants EMR.

In fact, I can tell you and list them off and name them right now, how many people have called us in the past 24 months saying, "We need EMR."

Our first question is, "Why do you think you need EMR?"

"Well, because we're going to be forced into it at some point."

Well, to us, that's not enough of a reason to go into this paperless environment. The bottom line is that we want to find out what their needs are, why they think they need a particular product and/or service, and if we can do the job then we will take that task and we will take that assurance to the client that if we "jump in bed together", if you will, that we'll both be glad we did.

We always welcome new inquiries. We are a growing business. We employ, not only our own technology group with TSI Healthcare, we own a major billing service that also handles the billing service requirements for our clients. So, we're kind of a multi‑faceted business. But, I will tell you this, that out of 1, 000 or so physicians that we serve, we've only got ‑ to the best of my knowledge ‑ one client that I would consider as not referenceable ‑‑ and that's a pretty good hit rate. I would say most physicians would be thrilled, out of 1, 000 patients, to have one that would not come back.

Robert: That is excellent. Do you accomplish this by a combination of finding highly motivated physicians to work with and your unique approach to service? Is that how you do it?

David: This is a whole new plank that these physicians are walking down, today. And yes, there are some of those that are, either young, and we've had some that are in their 60s and 70s pushing hard to go paperless...go paperless...go paperless. Well, you know as well as I do that there's no such thing as being paperless. We're not in a paperless world and the illusion that you're going to be paperless ‑‑ it is not going to happen, and probably not in our lifetime.

However, there are economies of scale and some maximization of the efficiencies, if you will, in these practices, that can be realized. Again, to better answer your question, if people who have an interest or are interested in learning more about what does this really means or what can an EMR do for that specific practice, that's where we come in and look at their situations. Find out, is there, first of all, a way to provide a financial return on the investment while, at the same time, not disrupting the practice beyond a reasonable level?

If you've got four doctors in a group, for instance, you're going to typically have two of them that are the older ones and two of them that are the younger ones. You may have two that really want to jump on and two that just are so close to retirement they may not even bother with looking into an EMR ‑‑ they're too far into their careers. We try to take that into account before we make a recommendation for a practice.

And as I said earlier, on a number of occasions, maybe now is not the right time. If that's the case, we advise our clients of such and check back with them ‑‑ maybe it's a couple years, maybe it's a couple of months; at a more appropriate time. But, we're not taking all comers.

Robert: David Dickson, President of TSI Healthcare. Very interesting and thank you for being with us at EMR Update.

David: Thank you so much for your time today.

You can contact TSI Healthcare at the following places:

TSI Healthcare
811 Ninth Street, Suite 200
Durham, North Carolina 27705

p: 800.354.4205
f: 603.676.5695

e: info@tsihealthcare.com
w: www.tsihealthcare.com

To read more of our EMR interviews, visit our Interviews blog here. If you have an interesting story to tell, why not get in-touch our resident journalist Robert Gleeman by email here.

Robert Gleeman talks with Peter Durlach, VP for Nuance's Healthcare Division

2008-10-09T07:07:00Z

This is a transcript and audio interview with Peter Durlach, Senior VP of strategy and marketing for Nuance's Healthcare Division. This follows up on the Medical Voice Recognition forum discussions about the differences between Nuance Dragon Medical and other (cheaper) versions of Dragon.

Click the play button below to listen to this interview.

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The following is a transcription of our interview.

Robert Gleeman: This is Robert Gleeman with EMR Update. I'm talking today with Peter Durlach. Peter is the senior VP of strategy and marketing for Nuance's healthcare division. Thank you for being with me today, Peter.

Peter Durlach: Thank you, Robert. Thank you for inviting us for this interview.

Robert: Now, as you know, we've had some heated discussion on EMR Update, in particular the sub‑forum on medical voice recognition. And I want to talk with you and maybe add some information to the debate. Maybe we can clear a few things up.

Peter: Sure. I'd be happy to.

Robert: First of all, how is Dragon Medical different from the other versions of Dragon NaturallySpeaking? And maybe you could go through the product family and give us a little background.

Peter: Sure. I'd be happy to. And there's a long history of the Dragon product, as many of your folks on your blog know.

So, historically, Dragon had a number of versions that ranged from some very basic consumer versions called Essential, Standard, Preferred, up to a version called Professional. And then, there were a couple of more vertically focused versions, one for medical and one for legal.

When you got to the Preferred and up, most of the differences ‑ not all, but the vast majority of the differences ‑ were in the high‑end, vertical solutions, the medical and legal, really limited to just the medical vocabulary, or what's called the language model, that shipped with the product. And this is the part of the system that includes the words that the user is likely to say and what the probabilities of those words are when they talk about whatever it is they're dictating about.

So, that was the historical difference between the products. And about a year and a half ago, when Nuance really started to focus on the medical market, we bought a company called Dictaphone back in March, 2006, and there's been a significant investment.

In the medical business, we decided ‑ and a lot of us were new to the company at that time ‑ that we really needed to add a lot more functionality and differentiate the medical from the other products, because we were getting a lot of requests for that, and also we felt the current differentiation, just being a language model, was not a very good way to segment the products. So, with version 10, we've made a lot of effort to start that process.

Robert: Who currently uses Dragon Medical, and who should consider using it?

Peter: Our best estimate, based on the data we have, is that we have over 70,000 clinicians of one flavor or not. They tend to generally be physicians, but we also have PAs and nurses and other folks that use it, across public, private, and government settings.

I'd have to say that it's both inpatient and ambulatory, but more than 50 percent is certainly in the ambulatory setting. So, it's really designed, primarily, for physicians, but again, other caregivers, who are dictating clinical documentation, either into an EMR or into Word or some other system that they're using in their daily basis.

Robert: I understand that some physicians were, or still are, using the consumer version in a medical setting. I also understand there have been changes in functionality with the recent announcement of Dragon Version 10 offerings, both medical and non‑medical. Some doctors have concerns around the cost for Dragon Medical, as compared with the lower cost of the consumer version. Why has the cost gone up so much on the medical version?

Peter: With version 10, actually, the cost of Medical has not changed. We made a change about, I believe it was November of last year, when Dragon Medical, we changed from $1299 single‑user list price to $1599. With Dragon Medical 10, there have been no cost changes, but the issue that some of the folks have expressed on your blog really have to do more specifically with some of the differentiation that we've done.

Some of the angst, specifically, has been the decision that we made to block dictation into a set of electronic medical records applications in the non‑medical versions of the product. And that's where I think some of the situation has arisen. I had a chance to read some of the blog entries on your system and on mine and catch up with that, so I'm relatively familiar with what has been said there and what the issues are.

So, the reason we did that was part of this effort to really start to differentiate the products, by both primarily adding new capabilities into the medical version, but also focusing on how we differentiate with the other products. And I know there's been a lot of angst about this, so I just wanted to give a couple data points from our perspective. I don't think it's necessarily going to answer the concerns of everybody, but I think, at least hopefully, people understand why we did it.

I also want to apologize, because part of what was supposed to happen ‑ and it did in many cases, but I noticed, on your blog, at least in one case it didn't ‑ that when Dragon 10 non‑medical versions were shipped, they were supposed to clearly state that we had done this blocking of the EMR in the non‑medical versions, and to make sure that everyone knew that before they had a chance to upgrade. I know, I've talked to a lot of physicians who did get that warning and made a decision, based on that, about what to do.

I noticed, again, in your blog, that at least one person, possibly two, had not got the warning. And that's really our mistake, and we apologize for that, because we did not mean to surprise anybody or kind of catch them off guard by that.

But, in terms of the decision to do it, first of all, let me just put this in context from our perspective. From a recent study in "The New England Journal of Medicine" this year, about 83 percent of physicians in North America don't use an EMR. And within the 17 percent that do, it's estimated that only about four to five percent use the EMR for the clinical documentation part of the process, for a CPOE or some other part of the system.

So, what we decided to do, as a result of the fact that, to make Dragon Medical really work extremely well with our EMRs, we really had to put a lot of effort into optimizing it to work with them, working with partners like Allscripts and Epic and Cerner. And we made the decision that the low‑end products, really going forward, should not have that functionality that was a really high‑end capability that we thought was appropriate for the medical versions.

And I know, in your blog, a number of folks have objected to our posting, using Microsoft Office and the various versions enclosed in that suite as a justification. And although we thought it was a relatively good analogy, we wanted to give another analogy today. Within the Adobe Photoshop example, the prices for that suite range from as low as $150 to $200, all the way up to $2500.

Robert: Yes.

Peter: And at the low end, they have a version basically for the consumer to take photos and make some basic edits, store and add some edits to the photos, and upload them for family members. And that's a couple hundred bucks.

At the high end, they specifically target features that they don't turn on in the low end, for really much more professional print/interactive/web/film editing, specifically for that higher‑end user.

So, for us, it's similar to that situation, where, in the high end, for us, the ability to really optimize your dictation in the EMR, for that still relatively small subset of the population, we felt was a reasonable thing to do from our perspective. We don't expect everyone to agree with that, but that was the rationale.

The other part that we have in terms of the cost differential is we put a lot of money into this product and we subsidize kind of the very low end of the product line, which can be gotten for as low as $99 to $199. We really need to be able to create a variance of price points along the value curve to make it a business sense. And although we're not trying to pick on doctors, but we are trying to put a lot of added value and focus on that we think the benefit is for physicians and why we think it's a fair price.

We also did get feedback from many customers that they tried the non‑medical versions and dropped using the product because they were not happy with the performance, the accuracy, et cetera. Now, that's not to say that everyone's unhappy. I know there's certainly users out there that are on Dragon Preferred and Professional and get very good results. So, it's not a blanket statement. But, we certainly have seen that in our studies as to the customer feedback on how they perceive their performance based on the different versions.

But, by no means are we asking someone who's on a non‑medical version, if they want to move to medical, to have to pay anywhere near the full retail price as if they were a new customer coming in from scratch.

Robert: Bringing that up, do doctors have any options if they want to keep using the non‑medical versions in a medical setting?

Peter: Yeah, absolutely they do. A couple of options they have ‑ again, most physicians today don't dictate into an EMR. So, if they buy the non‑medical versions of Dragon 10, or upgrade, they're going to be fine anyway.

For those that do, including the folks that were on your blog that were upset, there are a couple of options. One is they can continue on with their current version that they have. We support prior versions, goes back for two previous releases. So, whether they're on version eight or 9, we'll continue to support that. They also have the ability, again, as I said, if they want to upgrade but they're dictating into Word or something else, to go ahead with that.

So, we're not stopping them from using the product in any way. The only thing that we're really trying to say is that if you want to upgrade to Dragon 10, and you do dictate into an EMR, you really should consider moving to the medical version. You don't have to, but we think it's a good move, for a lot of reasons. And we've tried to make the cost not so prohibitive so that people feel that they have to pay a lot more money than they've already paid for their non‑medical version.

Robert: Speaking of cost, you hear a term called "return on investment," or ROI, spoken about quite often with software. What results can users expect, and when can they expect to get results?

Peter: We've done, over the last 12 months, a reasonable number of studies on productivity, both kind of formal studies and informal. And based on the data that we've gotten that have to do with lower transcription costs if the physician is used to using traditional transcription, versus handwriting, increased reimbursement and higher physician productivity versus pointing and clicking through a more traditional, template‑based EMR.

At the current prices, the list prices of our products, the full‑blown Dragon Medical, no‑discount, no‑small‑package version, at $1599, our average return on investment is under three months, which is pretty amazing in the software industry. I would challenge most people to find a product that produces an ROI in that kind of time frame.

Now, a number of your readers are going to say, "Yeah, but I can get that with the non‑medical version." And that's really what the question is. And I would argue that, although you can get, to some degree, that same return, if you really look at the capabilities of Dragon Medical 10 versus the non‑medical versions, the increased accuracy and productivity that we can provide to the physician, we believe that there is a pretty significant enhancement in terms of return on investment with one of the Dragon Medical versions versus the non‑medical.

On the reimbursement front, we are just concluding a study with a large, well‑renowned clinic here in the East Coast. And based on a controlled study that they have done, what they're seeing is that the physicians are 25 percent more productive at documenting care with Dragon than without. And then, in terms of increased reimbursement, using Dragon Medical, and the language model that's included in that specifically, on average, their data's showing that the average physician can increase their reimbursement roughly 500 to 2000 per year per physician.

So, again, if you compare that against the cost of the product, that's incremental to any savings they might get from any reduced transcription or reduced physician time spending within the EMR pointing and clicking.

Robert: What is new with version 10 that wasn't offered before?

Peter: We've done a number of things. In addition to rebuilding the language model to increase the accuracy of the system, we've also added very unique medical formatting rules directly into Dragon Medical that were not there in the same degree before. So, formatting rules for prescription writing or the way diseases are described is all automated, so the physician doesn't have to make those corrections or dictate in abnormal ways. And that's only available in Dragon Medical.

As a result of those two things and some core enhancements, the system has improved between Dragon Medical 10 and Dragon Medical 9. It's about 20 percent more accurate. And Dragon Medical 10, versus the non‑medical versions, is about 38 percent more accurate. And in terms of speed, all of the versions of Dragon 10 are about 100 percent faster than version 9. So, there have been some significant core‑performance improvements on that.

In addition, what we've done is we've really tried to optimize dictation in an EMR. So, what we've done is we've added, in the full medical version, a couple of key features. One is we've added specialized macros that can have variable fields in them.

So, if you're a physician dictating a common type of report, you can build a report with these variables in them and then quickly kind of dictate or tab through the variables to fill in the things that changes based on that patient encounter, versus having to dictate the whole thing or dictate standard blocks of text and then go correct the variable part of it. That's something we call Dragon templates, or macros with fields, which is a big capability. That's also in the Professional product, but we've really tried to optimize that in the medical.

The second thing that we've added that's only in the medical product is, often, in an EMR, clinicians will want to browse around the EMR to look for past notes or lab results while they're dictating. In the prior versions of Dragon, you were not able to do that. But, in Dragon Medical, you can actually move around the EMR, dictate in what we call Hidden Mode, and then come back to the relevant part of the note to insert your text. That's an important feature, again, for a person using an EMR.

The third thing that we've done is we've integrated our custom Power Mic, which is a hand‑held mic with a trackball, which really makes it much easier for the physician to navigate through templates, through an EMR, by voice. And although there are other microphones out there, from Philips and other ones, that provide conceptually similar functionality, we've really optimized that for use in the Dragon Medical products.

And there are a number of other features that are documented on our website and in our brochures, but those are some of the real highlights that we have.

One of the things that we'll be continuing to emphasize, though: we have some basic HIPAA supportive capability in the current version of Dragon 10, and we're making a big effort in the Dragon Medical product line, specifically, to enhance our HIPAA support, our encryption capabilities, going forward. So, over time, the Dragon Medical product's going to provide really significant, enhanced patient‑privacy capabilities that are not available in the non‑medical versions of the product.

Robert: Well, Peter, this is all very interesting, but I have one final question ‑ the main question my readers want to know. What can doctors who bought the non‑medical version do if they want to use it with their EMR?

Peter: Concretely, what people can do, just to be clear, we have two medical versions. We have a Dragon Medical Traditional, which has a list price of $1599, and a Dragon Medical Small Practice version, which is primarily for ambulatory settings with five physicians or less, for $1199. Those are the list prices that we have.

But, we have special promotions that we've referred to before that I just want to highlight here so people understand that we think there's a reasonable upgrade path that doesn't penalize people for being on a prior version of Dragon that's non‑medical.

If they're on a Preferred Version, and they would like to go to the SPE, the small‑package version, the list price of that promotion is $699. If they want to go from Preferred all the way up to the full‑functioning medical product, that's $1099. If they're on the Professional Version of Dragon and they want to go to the full medical version, that's $499.

We then have some very aggressive upgrades for prior medical version customers. So, for example, prior Dragon Medical version eight and nine customers can upgrade to version 10 for $249.

So, we think, given the added value that the product delivers ‑ much more than just turning off the blocking feature, but the other capabilities, with better accuracy, the Hidden Mode, the Power Mic integration, the automated formatting, and some of the HIPAA stuff to come ‑ we think those are reasonably fair prices, especially given the payback of the product.

Now, we know everyone's not going to agree with that. And I think, at the end of the day, everyone's going to have to make their own decision. As I've said, if a person doesn't feel that's worthwhile, they certainly have the option to stay on the current version that they have that's been working for them to date.

Robert: Well, Peter Durlach, with Nuance, thank you very much. I appreciate you being with us at EMR Update.

Peter: All right. Thank you very much, Robert.

End of Transcript

The Current State of the EMR Economy

2008-09-26T12:30:00Z

This is an audio-interview with Mark Anderson discussing The Current State of the EMR Economy. Due to severe damage to the Houston coastal infrastructure from Hurricane Ike, our interview is interupted as we re-establish contact from a call-wipeout. However, nothing can stop either a Texan or our intrepid blogging reporter Robert "ever-ready" Gleeman.

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Click the Play button above to listen to this interview.

This is the transcript from our interview, for those who prefer the written word.

Robert Gleeman: This is Robert Gleeman with emrupdate. I am talking today on "Casual Friday," on audio‑only with Mark Anderson, from the AC Group. Mark, thank you for being with me again today.

Mark Anderson: Well, I'm glad to be with you from lovely Houston, where there is no electricity anywhere to be found.

Robert: Well, we did try using our OOGL video interview technology and, for the first time, we were not able to get a usable signal. I hope that you will make it through this outage OK.

Mark: It's kind of interesting. If you think about the doctors that are around the Houston area who have had no electricity now for over a week, how do they see patients? And how do they keep their practice management EMR system going, especially when there is no cable connection?

The wireless is very poor now in the Houston area since most of the lines are down. It would be interesting to go back and see how physicians can handle using technology in a situation like we are having here in the Galveston‑Houston area.

Robert: This is a time of a real emergency, and I hope that things will get back to normal. How do you run your ranch with no power?

Mark: Luckily, I have a generator from before which I had bought a couple of years ago. We are running off of that.

Just last night, seven days after the hurricane hit, the stores now are starting to open up, and they are selling additional generators. Right now, I have three generators at the house running the basic stuff. No air conditioning here in lovely Houston, but at least I can have the refrigerator and lights and the fan running to keep us going.

Robert: We are pretty cool here right now in northern California. I think it is about 56 degrees. It is like fall here, now.

Mark: That would be nice!

Robert: I want to talk to you about something, Mark, that is going on in emrupdate right now. We have some very vocal and very verbose nay‑sayers, who are very quick to point out the problems with EMR and the problems with EMR vendors. But I want to talk to you about some of the positive reasons that people come to you as an EMR and EHR consultant. What do they have in mind? Why are they coming to you? And what are they looking for with EMR, Mark?

Mark: I think the big thing that we are seeing with physician practices today is that there has been so much talk about EMR that the doctors have been coming in and saying, "I know PQRI is coming. Now there are some bonuses. I know that the new e‑prescribing initiative is out there. We need to do something."

They are coming in and saying, "I want to get an EMR, because people are saying that I should have it. Now that I am looking, will it save me time and make me more money?" This is what they are really...

Robert: What they are really saying? It looks like we may have a poor connection on this line, too.

Man 1: We are on again, Robert.

Robert: Is it mostly what people are telling them they need to do, or is it the problems they are encountering with paper files?

Mark: No, I think if you look at the average physician out there, realistically they are not having a problem with the paper files. At least, it is not a big enough of a problem to switch over. Remember, most of the physicians can still hand write out their charts. It saves them time, right now, to hand write than it does to go in and click a thousand buttons to do everything.

A lot of doctors are saying, "Paper is faster." Now, if they have to dictate their notes... That is where the operational savings comes, if you can get rid of the dictation. But most of the physicians I talk to are not happy with the output that comes out of the EMR. It is not in the same format that they do today.

We have to find a way of making sure we save them time, help them to make more money, and to make sure that the note at the end comes out that clearly looks like something that they would have written or dictated... not a computer‑generated list of problems.

Robert: In other words, what is driving doctors to EMR is not so much the problems with paper or cardboard files as it is what they are hearing about pay for performance, better follow‑up on chronic illness, some of the different ways of keeping track of diabetes and so on. That is what is driving them more so than problems with paper.

Sorry, Mark. We had another drop out there...

Houston, we have a problem! Let me try to make that call back. [phone ringing] ...other types of utility problems. Mark? [phone ringing] We will try it once again.

Mark: I am moving to another section of the house. Maybe, I will have better reception.

Robert: [laughter] Well, we are certainly live here. I did not stop the interview, Mark. I just redialed you. I guess we are having some real utility problems here.

Mark: Yeah.

Robert: Folks, please remember that we are talking to Mark Anderson from the AC Group in Houston, several days after a major hurricane storm. There is no power in Houston. Mark is running on generator power, and we are trying to find a location where we can continue the interview.

Mark: OK. Let's try this.

Robert: OK. I can hear you pretty well at that location, Mark.

Now, we were talking about some of the reasons that drive doctors to look into EMR. You were telling me that it was not so much the problems with paper, because that is what they are trained on, as it is the things that people tell them about pay for performance and better response to chronic illnesses. Is that pretty much the case?

Mark: It depends on the specialty. For instance, primary care physicians that are your family physicians, internal medicine and even pediatrics... They are reimbursed, and they are trying to take care of more problems of the patient. In other words, diabetes with CHF... They are trying to help those patients stay a little bit healthier.

The issue is, again, that the majority of the physicians out there are specialists. They are really not taking care of all of those other issues. So, having an EMR that helps document diabetes and get people back in for health maintenance alerts really does not benefit many of the specialists that are out there.

For example, orthopedic doctors... They don't really do that many lab tests. Traditionally they are taking care of a broken bone or a sprain or a torn rotator cuff. They are not treating the health of the patient as much as the family physician would. Therefore, the requirements for EMRs are so different between the specialists and the family practice doctors out there today.

Robert: Do the specialists have a lot less requirements? Are they easier to work with and satisfy?

Mark: They have a couple of requirements. One of them is a lot less data entry, because they are traditionally not doing as detailed a review of systems. The HPI is related to the one issue that they are looking at.

And their order sets are a lot easier. They do not order as many lab tests. Their x‑rays are pretty simple. Their medications are typically limited to eight to ten primary medications that they recommend.

Their requirements are a lot less. But, their requirements for replacing the transcription are very high. They want that note to look like something that they would have transcribed. Most of the EMR vendors do not really provide a nice‑looking note that comes out that looks like what a physician would have dictated.

Robert: What would you say are some of the happiest customers of EMR and EHR? Are they the specialists, or are they the general practitioners? Who seems to do the best, in your opinion?

Mark: We have done a number of studies on both the family physician side and the specialists.

We have found that there are extremely happy specialists out there if they can get rid of their transcription and, specifically, when they allow the patient... their nurse or MA, to really enter in a lot of the information. The basic family history, social history... to get all of that information... and then have the nurse or the MA do the review of the systems and HPI.

The specialists really like the product when all they have to do is review the information, walk in, talk to the patient, do their physical exam and then they put their information in. That is what seems to work with the specialists out there... when they do their first data entry after the physical exam. They are happy with that. It does save them time, and it does help them replace their transcription.

I would say that I have about, probably, 60 percent of the specialists are still using Dragon for portions of the dictation. They are basically dictating right into the EMR their final assessment. So, they are still getting all of the E&M coding ‑ you know the clicks and buttons ‑ because someone else is putting that in. And they are still making the note look like something they would have dictated, because they are using Dragon to get part of that out.

For the family physicians and internal medicine doctors, typically we see that they are happier with the product if they are growing in size. For instance, SETMA, which is a large physician group out here in Beaumont, Texas, has been extremely successful with their EMR, but they started with five doctors and now they have 26 doctors. They have grown and they have not had to add cost on. They went from a staffing ratio of 6.5 staff per doctor; five years after implementing the EMR, they are now at two staff per doctor. So they have actually cut their staff in half by growing.

Very hard for a family physician of one or two to put an EMR in and actually save any time, because, you have to have all of that staff. There is a minimum staff no matter what. In SETMA's case, they were able to grow their practice through the use of the EMR. And, because they are doing a lot more work on health maintenance alerts in keeping people healthier, they have won a number of awards.

They are getting paid more now, because they actually have a good EMR that is driving the health of the population in their community.

Robert Gleeman: How are you spelling that, SETMA?

Mark: S‑E‑T‑M‑A.

Robert: I see.

So, it sounds like there are many, many doctors using the EMR happily and with good effect and good results. I guess what I'm asking you, Mark is: in your opinion, what are some of the things that make for a happy EMR customer?

Mark: I think if we can get a way of getting the EMR to work around the workflow of the physician practice, instead of the physician changing everything they do to work around the software product, that is where we see success.

Robert: Yeah.

Mark: Because the EMR is just the tool. What we are doing with all of this training and everything that everyone is offering, is that we are showing people how to use the tool only.

But, it is like building a house. We are showing them how to use a hammer without building a house. We have got to get a lot more as far as, how do we really use this to save time and make money? They vendors are not spending the time. Or, more likely, the doctors are not willing to spend the money to make sure that they look at what we call "clinical and operational transformation." How do we get the software and office workflow to work together to save time and make the doctor more money?

No one is doing that. They are only installing software and going, "Doctor, you are on your own. You figure it out from here."

Robert: [laughter] It is a very difficult product for a vendor to sell, isn't it?

Mark: The sale cycle is so long. I have talked to practices that have been looking for two years for a software product. But, I am working with a family physician out of Kentucky who called me last Friday. He said that he wanted to buy an EMR and a practice management system and get it installed by November 1st. We spent four days in a row doing webcast demos, and today he is signing the contract.

So, within seven days, he went from "Gee, I would like to get something," to signing a contract... within seven days. It can happen! You can sell quickly. But you have to have a doctor who is motivated. In this case, the doctor had all of the information he wanted. He looked at six really good products and made his decision relatively quickly. So it can occur.

Now the next question, how successful will he be using the product, will really depend, not on the product but how well the product integrated into his workflow and the process going forward.

Robert: I wanted to ask you a question. You don't have to answer this if you don't want to, but these are very tough times in the stock market, and there is an election going on which is very heated. How are times for EMR sales right now?

Mark: Well, when I talk... they claim that sales are the best they have ever been. Then I go back and look at the results. I would say that EMR sales are down about 35 percent from the last year. I think what ends up happening is that every vendor wants to keep a glorified story out there. Everything is great. We are selling like [audio cuts out].

I talk to a lot of doctors, and a lot of them are just putting off their buying power. Partly because they are still saying, "Hey, I am going to wait and see what the hospital does. I am going to wait to see what the MSO or the IPA in my community does, because they are looking at EMRs.

I think that there are still a lot of potential clients out there who are looking. But we are finding that a lot more of the bigger doctor groups are looking instead of the individual physicians.

So, I think business is really hurting most of the vendors today.

Robert: I think that this is showing that the economy affects everybody: doctors, EMR vendors, EMR consultants...

Mark: Yeah.

Robert: As a parting shot to the doctors in "emrupdate," that read "emrupdate, "what can you tell us about now, in this time, at this moment in the economy and in the country? Is it a better time to go to a consultant than ever?

Mark: If I was small physician practice looking for an EMR, I would not call a consultant. I would sit back and wait to see what the community is going to do first. No sense in going out and spending money, buying EMR that may or may not be connected to the rest of the community in the near future.

I would go to the hospital administrator, your MSO, your IPA, whatever you belong to, and start talking to them about them putting together a community EMR. That way, we can start sharing data. So, the patient goes to the primary care doctor and they collect the information. That information goes directly into the specialist's EMR. So we don't have duplicate data entry.

I think, realistically, we have to stop buying individual silos of computers and get more of a community‑based EMR going. That is where I think the market is really going to go, and that is where the government has been talking about. If you look about the whole CCHIT stuff now, it is all about creating standards for community systems. That is the new one they are working on today. That is where we everything going.

Wait until your community does something and get connected into the community.

Robert: Are you geared up to be involved in that and to help with that process?

Mark: Right now, I would say that 90 percent of our business has switched away from helping physicians to really working with these larger communities. Because, the communities... With the change of the Stark Law, there are some major changes going on, where communities are starting to say, "Maybe we should start looking at bringing together a community."

Maybe in our next session we can talk about the financial benefits for the patient, the employer, the healthcare plan, the hospital and the doctor, by going to more of a community‑based EMR versus silos of information.

It is kind of like here in Houston... We all don't have our own electrical plants. We all share the same electrical service. But, then again, it is good to have a back‑up system, like a back‑up generator for when the whole community goes down. Even though I keep promoting community‑based EMRs going forward, every individual physician still has to have a back‑up procedure in case the community is not working. ...like we have here in Houston, with 2.5 million people without electricity seven days after the hurricane hit.

Robert: I hope you recover well from that. It sounds like you are pretty self‑sufficient with generators and all. We did get our connection. It wasn't easy, but we did get it [laughter].

Thank you very much, Mark. I appreciate the extra effort to communicate with me today.

Any final thoughts for our readers?

Mark: I think the main thing is for doctors to continue to be vocal. If you don't like what you are seeing, tell people about it. We need to make sure that the message is getting out there, that some EMRs are working well and the lousy EMRs are not working well for the physicians. It is up to the physicians, who are the users of these systems, to be more vocal and to let people know where it works and where it doesn't work.

Robert: Well it is good to hear that you are pro‑physician, and that is the position that we take at "emrupdate."

Thank you very much, Mark Anderson with the AC Group for talking with me again on "Casual Friday." Thanks, Mark.

Mark: Thank you.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here and more Interview here.

The HealthCareOne ASP EMR

2008-09-22T12:14:00Z

This is our interview with Karen Geotz, CEO of HealthCareOne.

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Click the play button above to listen to our interview.

HealthcareOne

Robert Gleeman: This is Robert Gleeman with EMR Update. I am talking today with Karen Geotz, the CEO of HealthcareOne. Karen, thank you for being with me today.

Karen Geotz: Oh my pleasure.

Robert: HealthcareOne makes an EMR and this came to my attention because of one of your VARs, Kelly Walsh at Adair Consulting saying that you have a very unique type of software that doesn't require the doctor to make a huge change in what he is doing, is that correct so far?

Karen: Yes.

Robert: And what type of software is HealthcareOne, is it something that resides on a server in the doctor's office or is it an ASP?

Karen: An ASP.

Robert: OK, so there is no server really required, just a good connection to the Internet?

Karen: Yes, that's right.

Robert: And what type of computers do the doctors usually use with this system, is it tablets?

Karen: Yes, it is usually tablets, but for physicians that don't write and are comfortable dictating or typing, they don't need a tablet, they could use just a standard PC. But the tablet PC more simulates the chart that they are currently using, so that seems to be the preferred way to go electronic.

Robert: So actually what the doctor is presented with on the screen is very similar to the paperwork that he has been using?

Karen: Exactly.

Robert: And do you customize this for each person or is it the general knowledge of medicine has laid it out for you?

Karen: We actually have spent years talking to physicians and practice administrators at different offices and we realized that there is really no way to come up with a cookie cutter solution to the electronic medical record dilemma, because every specialty is different and even within each office, doctors as individuals practice differently and they don't like to change, because change slows them down and slowing down means less revenue for the practice.

So we have approached this whole dilemma by creating a system that does indeed replicate the paper charts and the process that is in place and working within a practice today. So what we do is look at the chart, typical patient chart in the office. We see what tabs they have in the chart. We look at every single form that is behind each of those tabs and then we take those pieces of paper, those forms, and we make them electronic. We replicate them exactly the way they are in paper and the tabs that we build in our system replicate exactly the tabs that are in the patient chart.

Robert: That sounds like almost a customized system for each client?

Karen: Yes.

Robert: Doesn't that take a tremendous amount of time and work?

Karen: No, because our software enables us to do that quickly. That's why it took us many years to create, but by creating it this way we are able to actually get these templates converted from paper to electronic in just a matter of either a few hours or a few days and we are able to then get started on an installation very quickly because there is no software system that they have to learn. They are just using their same existing system, only it is electronic instead of paper.

Karen: Yes, that is correct.

Robert: OK. Well, it is a beautiful website and I see there that you can get an online demo and just so you know, in the forum, your consultant has been beat up and shredded for not having pictures and demos on the website that you can see without registering, so I just thought I will let you know [laughs].

Karen: OK [laughs]

Robert: This is a very tough forum. And you know what I want to do is bring attention to your product, but I just want to let you know that as I do that and as we talk and talk more, you will be given suggestions in the form of demands pretty much from our readers [laughs] .

Karen: Oh that is fine. This is really just the start of our website to give a good overview of who we are and the fact that it is customized per practice based on their existing charts. But that isn't to say that we can't overtime put some kind of demo up and basically say, this is just an example...

Robert: An example, right.

Karen: ...of what has been done at this practice.

Robert: HealthcareOne is not a new company, you have been around since you were founded in the year 2000, but you put about $10 million worth of research and software development into this system, so I think it is definitely something our people should be aware of. How quick can you do a demonstration for someone when they call in and sign up?

Karen: Well, we can do one the next day.

Robert: Why do you think people like this software?

Karen: Well they like it because they don't have to learn some complicated software package. They don't have to go offsite for a day or two or three and learn a whole system with all of its drop‑down menus and forms. They like the fact that they don't have any upfront software license fee to pay. They don't need to have an expert IT person on staff that is going to have to roll this out and then support the technology. And they like the fact that they can get this system installed in a matter of weeks instead of months with no disruption to the office and no decrease in the amount of patients that they see.

Robert: One thing that also caught my interest on your website is your EMR software interface, HealthcareOne's software can be installed and interfaced with other EMR systems. This means that even if you have an EMR system, this might be something to take a look at?

Karen: Yes. We have several large customers who had purchased some of the large EMR systems before they knew about us and it was very cumbersome for their practice to use, it was slowing them down. We can interface to those EMRs and then do the documentation like we do and then put it into the EMR system that they have.

Robert: The EMRUpdate’s 5,000 or 6,000 doctors that read EMR Update, why should they give you a call?

Karen: They should give us a call because they need to know and they need to see that there is an alternative out there to that traditional EMR that they think is way too costly and way too cumbersome to use and will slow their office down. We have a solution that addresses all of those difficulties that are associated with that term EMR.

Robert: Excellent. CEO of the company called HealthcareOne, we are talking with Karen Goetz. Karen, thank you very much for being with me today on EMR Update. Thank you.

Karen: Thank you Bob.

You can contact Karen Geotz via HealthCareOne or the following contact details:

Corporate Headquarters
HealthcareOne
235 Walton Street
Syracuse, NY 13202
Phone: 315-422-1599
Fax: 315-422-1688

This is a tag representation of our interview.

PracticeIT's free EMR Lite with the critical functions that Docs need.

2008-06-05T19:45:00Z

This is our interview recorded with Rich Steinle, CEO of PracticeIT talking about their free EMR Lite product "with all the critical functions that Doctors need".

Click the play button below to listen to this interview.

Robert Gleeman: This is Robert Gleeman with EMR Update. I am talking today with CEO of PracticeIT, Mr. Rich Steinle.
Rich, thank you for being with me today.

Rich Steinle: Thank you Robert, it is good to be with you again.

Robert: We talked a while back and did an audio interview before and in this case we wanted to catch up and see what has been going on new at PracticeIT, because I recently did an interview with Mark Anderson and he mentioned that you do sell a Lite EMR and this is being discussed intensely right now at EMR Update, what have you got new for me Rich, what is going on?

(Please visit the site to view this media)

Rich: Since we last talked, one of the biggest things we have been doing is listening to doctors. I mentioned last time to you that's a commitment of PracticeIT's. And what I believe that we have learned is when you talk about an EMR Lite, what we have learned is that I don't think doctors want necessarily less functionality or less help. They just want to know that you have the critical functions that they need to run their office.

And so we call that either an ante or a table stakes, but the things that are important to them and you have to have them, so we haven't found doctors not interested in software, but what we have found and what we believe is that software is not what is winning in the industry alone.

And so what I mean by that is when you convince a doctor that you have the critical functions that they need, then what we see is, well then what is causing the adoption problems. And if you look into the industry and you study the statistics and Mark Anderson and his report are the source of a number of these, just one source, but you learn in the physician practices that we are serving of under 10 doctors and particularly the one to three that you have paltry adoption rates in the eight to 12% range.

Then you look at the people that have adopted and it gets worse. And it says that up to three quarters of them aren't even using their EMR, after a year of adoption. We don't think that software wins the day. The industry is known just abhorrently poor customer service and support and when we talk to doctors what we hear is, that no comes alongside me and helps me put this into my practice.

There are too many options out there for software to be the answer. You can get just about anything from anyone and so we have taken it a step further and said if that is the problem, if they don't have a partner, if doctors don't have a partner that is serving them, then what we are willing to do is say, well then we will build our company around that and that is all you will ever pay for.

And so PracticeIT has taken the bold step of saying you can have the software. We will give it to you and you never pay for it. It is not a pricing scheme, you don't pay for it later, we don't hide it in anything. Most of the companies in the industry charge you for the software whether it is on a monthly basis or a large upfront fee and then they charge you for their service contracts or their training.

PracticeIT is willing to say the risk of adoption, the poor adoption of these in the industry, the reason they are not helping doctors is because they are not being served well. And so that is the only thing that we are going to ever charge you for is we are going to give you our people and our service model and we are going to come alongside you, let you adopt it at your pace, we are going to make it unlimited and include everything in that service fee and we are going to give you the software.

Robert: And the software will reside in your practice's office on a server?

Rich: No, it is a hosted solution ‑‑ that hasn't changed, so typically our competitors are out there charging a monthly fee for that, but then they also charge all the training and service fees along with it. And we are saying no, everyone ought to be able to have one of these, we would like to commoditize the EMR if you will. It ought to be as resident and basic in a doctor's office as the stethoscope, as their printer, their fax machine.

Doctors ought to be able to have one of these and companies ought to make it easier for them to have. And so we are going to come alongside of them, give them the software that has all the critical functions which gets back to the EMR Lite conversation, but then we are going to come alongside of them and make them successful.

Robert: Now I understand that not only do you give the critical functions, but you have gone a few steps further into areas where even the EMR heavies don't go.

Rich: One of the things that we are really trying to do Robert is not make Lite a cop‑out in the technology. And so want to be really careful and communicate that that we are not trying to take them out by saying, well we will just drop off early as far as the software goes.

And so as an example, some of the lighter systems stop at, we are a charting system or they go into e‑prescribing and have some simple SOAP note or something. And what PracticeIT has done is say: no, doctors really do deserve and want the full integrated functionality.

And so to that end, we have integrated a complete practice management system into our EMR for seamless integration all the way from the front desk through charting and then all the automated clearinghouse, billing services included. We have also gone a step beyond even with some of the industry leaders in the full EHR have, which is a full bidirectional automated laboratory interface.

Robert: Ah, that is unusual.

Rich: Yes, so that is not very present in a lot of the lite systems and it is even not present in some of the leading full EHR packet. So again, we are working hard with our physician advisers and saying, we don't want to shortchange on the software, we are just making the case that that's not what is making the industry successful. As a matter of fact, the lack of what we are offering which is the high‑touch high‑availability service is what is making it fail. And so that is where we have decided to put the focus and we are getting a phenomenal response from the physician community.

Robert: How can someone find out more about this, how can they sign up?

Rich: Well, they can always visit our website at PracticeIT.com. And there are lots of ways to contact us there. They can call me directly and I will be happy to chat with them or any of the folks that we have here at PracticeIT, because at the end of the day what we are selling is those people and how we do it.

Robert: What would be a good phone number to call you there to get more information?

Rich: 866‑PRN‑4111.

Robert: OK, great. What else can you say to the readers, the many many doctors that read EMR Update about PracticeIT, why should they give you a call there, Rich?

Rich: We have created this company in the face of really almost the unmanageable level of choices that doctors face today to directly respond to their needs. It bothers me that more than eight to 10% of small independent physicians can't have a viable option or don't see a viable option in front of them given the 300 to 400‑odd choices that they these days. And the fact that they come back from reviewing those choices more bleary eyed than encouraged is a disappointment to me.

And so I think that really my message to them is that we have tried to hear that and we have spoken with the physician community. We believe they need key software functionality. We are going to offer them this and we are delivering that, but more than that we have heard that they need a partner. And we come alongside them and we will guarantee their success that way.

And the best way I think to communicate that to them would be to maybe talk to some of our satisfied physician partners right now. And if they give us a call, we can put them in touch with those folks and they can get a firsthand experience of what that feels like, and the difference I think PracticeIT can make.

Robert: That is excellent Rich Steinle, CEO of PracticeIT. Thank you very much, Rich.

Rich: Thanks very much Robert.

Richard Steinle, CEO of Practice IT can be contacted at the numbers below:

Toll Free: 866 PRN 4111
(866) 776-4111

PracticeIT, LLC
9600 Great Hills Trail, Suite 350W
Austin, TX 78759

Donald Schoen, CEO MediNotes Corp. talks about the recent acquisition of Bond Technologies

2008-04-08T05:56:00Z

This is my interview with Don Schoen, CEO of MediNotes Corporation where we discuss their recent acquisition of Bond Technologies.

We talk about what this means to existing Bond Technologies customers, the support model and how MediNotes will manage on-going customer support for their two product streams. We also talk about on-going dvelopment and how MediNotes is going to manage two teams of developers.

Click the Play button below to watch our video interview.

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MediNotes can be reached by Toll Free number 1-(877)-633 6683 and email info@medinotes.com

MediNotes Corporation
1025 Ashworth Road, Suite 222
West Des Moines, IA 50265
Fax: 515.327.8856

Thanks for watching!

Robert Gleeman

For more detailed information & press about MediNotes Corp. contact:

The following press releases accompany this interview.

MediNotes Completes Acquisition of Bond Technologies

Company establishes separate national sales forces for best of breed EHR and its newly- renamed integrated EHR/PM Solution

WEST DES MOINES, Iowa - March 17, 2008 - MediNotes Corporation, a leading provider of certified electronic health record (EHR) systems, announced today that it completed its acquisition of Bond Technologies.

The two companies announced on Feb. 25 that they had signed a letter of intent for MediNotes to acquire Bond Technologies, which offers the industry’s most advanced integrated, award-winning .Net-based EHR and Practice Management (PM) solution. Following the merger, MediNotes renamed that solution from Bond Clinician™ to MediNotes Clinician™. It also created separate national sales forces to market MediNotes Clinician™ EHR/PM solution as well as MediNotes e, its best-of-breed interoperable EHR. MediNotes is the only healthcare IT vendor offering physicians the choice of either a stand-alone EHR or an integrated, single-vendor EHR/PM system.

“The merger positions MediNotes to become an even stronger force in our industry by offering solutions that meet the needs of small to large physician group practices,” said Donald G. Schoen, president and CEO of MediNotes. In addition to investing in the further development of MediNotes Clinician, which includes e-prescribing, patient portals, patient kiosk and image management, MediNotes will continue to develop and support MediNotes e and its users.

About MediNotes Corporation

MediNotes Corporation has been a leading provider of electronic health record (EHR) solutions for more than a decade. With product offerings to fit any sized medical practice, MediNotes offers an integrated EHR/practice management (PM) suite, as well as a best-of-breed EHR solution that allows MediNotes to meet a physician practice’s evolving needs. Installed in more than 4,700 sites nationwide, MediNotes EHR solutions are utilized daily by more than 22,500 medical professionals. MediNotes solutions offer physician practices industry-leading technology and product reliability, coupled with superior U.S.-based service and support to meet their dynamic technology needs. Their certified products include MediNotes e version 5.2, a CCHIT Certified® product for Ambulatory EHR 2007. MediNotes Corporation is headquartered in West Des Moines, Iowa with a satellite office in Tampa, Fla. To learn more about MediNotes and its family of products visit www.medinotes.com or call 877.633.6683.

MediNotes to Acquire Bond Technologies

Physician practices of all sizes benefit from an award winning, ASP.NET integrated EHR/PM application provider or best-of-breed offerings

ORLANDO (HIMSS) – Feb. 25, 2008 – MediNotes, a leader in electronic health records (EHRs) with more than 20,000 users nationwide, announced today that it has signed a letter of intent to acquire Bond Technologies. Bond’s integrated award-winning .NET-based EHR and practice management (PM) solutions include e-prescribing, patient portals, patient kiosk, image management and more. MediNotes’ strategic addition of complementary healthcare technology solutions includes a full range of integrated, single-vendor and best-of-breed EMR and PM solutions to enhance patient care and workflow, as well as the patient experience. The announcement was made at the HIMSS 08 (Booth # 4363) Annual Conference and Exhibition in Orlando, Fla.

“Physicians want the best technology now, but need assurance that the solution they choose today can evolve to meet their needs,” said MediNotes CEO and President Donald Schoen. “When this acquisition is complete, MediNotes’ will have the ability to provide a full range of scalable solutions ranging from a best-of-breed interoperable EMR offering to a fully integrated, single-database, .NET-based EHR and PM solution with image management, e-prescribing, patient portals, patient kiosks and many other popular features. Instead of the cookie-cutter approach some vendors employ, we help practices leverage their IT investment by allowing them to develop the ideal configuration to address their current needs with a cost-effective migration path to fully support change and growth.”

Augmenting its specialized product lines with Bond Technologies’ award-winning practice management software and small to large-practice EHR solutions, Bond Clinician™, MediNotes will create a one-stop-shop to meet the needs of all types and sizes of physician practices. The company will continue to provide MediNotes e, its popular stand-alone EHR.

According to Travis Bond, President of Bond Technologies, who will serve as MediNotes Senior Executive Vice President and Chief Strategy Officer, “Bond Technologies’ passion has been to create the best technology for the healthcare industry. This acquisition will leverage MediNotes’ national presence and U.S.-based customer service expertise to serve physicians across the nation. I look forward to the challenges of taking on new markets and meeting the opportunities of improving healthcare IT.”

About MediNotes Corporation
MediNotes Corporation has been a leading provider of electronic health record (EHR) solutions for more than a decade. With product offerings to fit any sized medical practice, MediNotes offers an integrated EHR/practice management (PM) suite, as well as a best-of-breed EHR solution that allows MediNotes to meet a physician practice’s evolving needs. Installed in more than 4,700 sites nationwide, MediNotes EHR solutions are utilized daily by more than 22,500 medical professionals. MediNotes solutions offer physician practices industry-leading technology and product reliability, coupled with superior U.S.-based service and support to meet their dynamic technology needs. MediNotes Corporation is headquartered in West Des Moines, Iowa with a satellite office in Tampa, Fla. To learn more about MediNotes and its family of products visit medinotes.com or call 877.633.6683.

About Bond Technologies
Bond Technologies, a leading developer of clinical software, offers the industry’s most advanced, integrated Electronic Health Record and Practice Management software available today. Bond Clinician™ EHR/PM Digital Medical Office of the Future infuses the workflow with an easy to use Microsoft ASP.Net application, allowing physicians to experience an innovative, intuitive, and intelligent EHR embodying every element of the practice of medicine at an affordable price. Bond’s Clinician has been awarded many top industry awards including the TEPR 2007 Pediatric Documentation Challenge and the AC Group’s 5-STAR rated EMR solution for the last four years. Visit www.bondclinician.com for more information.

MediNotes e Receives 2007 CCHIT Certification

Software Complies with 100 Percent of Updated 2007 Certification Criteria

ORLANDO, Fla. (HIMSS) – Feb. 27, 2008 – The Certification Commission for Healthcare Information Technology (CCHIT®) today announced that MediNotes’ product, MediNotes e is CCHIT Certified®, and meets the Commission’s ambulatory electronic health record (EHR) criteria for 2007. Ambulatory EHRs are designed for physician offices and clinics where most Americans get their healthcare. CCHIT – an independent, nonprofit organization – is the Recognized Certification Body in the United States for certifying health information technology products.

In the second year of the program’s operation, the criteria and testing have been significantly enhanced. The Commission added 96 criteria to the 151 original requirements from last year. As a CCHIT Certified product, MediNotes e has been tested and passed inspection of 100 percent of a set of updated criteria for functionality, interoperability and security.

“For 2007, the Commission raised the bar from the previous year’s criteria. Ambulatory EHRs now must include electronic prescribing, demonstrate an ability to receive lab results, and show enhanced patient safety, quality, and security features,” said Mark Leavitt, M.D., Ph.D., chair, CCHIT. “Investment in 2007 certified ambulatory EHRs gives providers even more powerful tools to improve quality, safety and efficiency while protecting the privacy of health information.”

The CCHIT Certified mark — a “seal of approval” for EHR products — provides the first consensus-based, government-recognized benchmark for ambulatory EHR products. By looking to products with the CCHIT Certified seal, physicians and other providers can reduce their risk in selecting an EHR product, allowing them to focus their evaluation on the special needs of their practices.

“The CCHIT certification is a testament to MediNotes’ commitment to evolve our product offerings to meet the highest standards of our clients who prefer a ‘best-of-breed’ approach in deploying technology in their practices,” said Donald G. Schoen, CEO and president of MediNotes. “Coupled with our recently-announced intent to acquire the award-winning EHR/PM of Bond Technologies, for practices that prefer a fully-integrated, single-system approach, we are clearly executing an ‘evolve’ strategy in becoming a single-vendor resource for practices of all sizes.”

CCHIT’s certification compliance criteria and its design for a certification inspection process have been thoroughly researched, taking into account the state of the art of EHRs and available standards, and comparing certification processes in other industries and other countries. The inspection process is based on real-life medical scenarios designed to test products rigorously against the clinical needs of providers and the quality and safety needs of healthcare consumers and payers. One script, for example, recreates a scenario of an elderly man with poorly controlled diabetes, hypertension and other chronic conditions in order to test EHR functions such as potential adverse drug reactions, disease management and treatment plans.

About CCHIT

The Certification Commission for Healthcare Information Technology (CCHIT®) is an independent, nonprofit organization that has been named by the federal government as the Recognized Certification Body for health information technology. Its mission is to accelerate the adoption of health information technology by creating a credible, sustainable certification program. The certification requirements are based on widely accepted industry standards and involve the work of hundreds of expert volunteers and input from a variety of stakeholders throughout the health care industry. More information on CCHIT and CCHIT Certified® products is available at www.cchit.org.

“CCHIT®” and “CCHIT Certified®” are service marks of the Certification Commission for Healthcare Information Technology.

Kirk Voelker, MD talks with Nick about EMR/u, that Smoking Shot, Placebo/Sham and his practice

2008-03-03T09:34:00Z

As I was in Florida I took the opportunity to spend a few days with Kirk Voelker and his wife Chris (not forgetting the muts Sara, Toby and Vito).Kirk Voelker started emrupdate.com in 2002 while researching an EMR for his own practice Lung Associates of Sarasota, FL. This started as a simple message board and links using Microsoft Frontpage and the basics of web-site publishing. We wouldn't be here if it wasn't for Kirk Voelker, MD.

In exchange for my interview for his QuitDoc Smoking Treatment Network to be published this month, Kirk agreed to give me an update on what he's been doing since we last met. I also had a cunning plan to have Kirk commit to more posting at EMR/u. Let's see how I get on.

(Please visit the site to view this media)

Laser Treatment investigations

Kirk mentioned in our interview his investigation of the Laser treatments (FDA reports here) being used for Smoking Cessation. I originally thought, ok, something complementary for helping folks to quit smoking. (in the same vein as Alan Carrs The Easy Way to Stop Smoking which didn't do me any harm -- some of its messages probably helped)

After our interview Kirk explained that because no actual trials have been completed into this treatment, these operations can continue operation still claiming they have some scientific benefit for Smoking Cessation. With the aim to prove and publish his trial findings -- that Laser Treatment is a sham -- he's currently running a double blind placebo/sham with 60 QuitDoc patients.

The "Laser treatment" uses one of two different laser frequencies aimed at around 40 "points" around the body from fingers, ears, scalp, etc. The two frequency lasers and the dummy LED light (looks identical) are color coded and used blind to "treat" different patients. Kirk recounted one female patient who had described an epiphany -- a golden aura and feeling of intense happiness -- when the laser had been applied to her scalp. She claimed that she knew she would never smoke again. After the patient's departure her name / color was checked and found to be a "treatment" using the sham LED light.

Dr. Voelker is on his way to removing this scam from Smoking Cessation treatments. I'm also interested in his Stop Smoking Foundation mentioned during the interview. Maybe we should invest in the future of America's children.

Our Site Statistics

We we're trying for a one-hit recording, and clearly I didn't do enough preparation for the interview.
I completely failed to answer Kirk's question accurately detailing our site hits or pageviews;
I did quote between 1,000 and 2,000 Visitors per day, but should have included the following:

Pageviews for all visitors

105,099 Pageviews

February 1, 2008 to February 29, 2008 Daily

30,284 Visits

Av. 976.90 Visits / Day

Our thanks to Kirk Voelker, MD for taking the time to be interviewed again for our web-site.

Thanks -- Nick Harrington

Interview with Mike Patel, CEO, Meditab Software and T.J.Wilkinson, Medetron

2008-02-19T03:44:00Z

This interview is provided as a YouTube presentation and text transcript.

To play the YouTube movie, scroll down and click the play symbol on the Blue title screen.

Robert Gleeman: This is Robert Gleeman with emrupdate. I'm talking today with Mike Patel, CEO of Meditab Software, Inc, in Oakland, CA. Mike's phone number is (510)686‑8417. Mike Patel, thank you very much for being with us today.

Mike Patel: Thank you for inviting us.

Robert Gleeman: Mike, the reason that I wanted to talk with you is an associate of yours, T.J. Wilkinson, in his very first post on emrupdate, said that the Meditab software was the best software he had ever seen in his entire life. Now, I know we all love our own software. But, what is it about Meditab that encourages people to say things like that? For instance, are there tabs in Meditab? What does the name mean?

Mike Patel: We, basically, have a history of developing outstanding software. And, the way we came up with the Meditab name was when the Tablet PC's were initially coming out, I had a friend that used to work for a company called Pace Blade, and then, Motion Computing.

I was reading all of the hype and then I actually convinced him to let me play with a Tablet PC that was in a plastic engineering mold. Then, I said, well, we really have to take advantage of this thing. And, so the way the name actually was derived from Medicine on a Tablet PC.

Robert Gleeman: Ah hah! I would have, I would have guessed otherwise. I'm glad I asked you that question. And, Mike, do you have a background in medicine? Do you come from a family that has doctors? Well, how did you get into EMR?

Mike Patel: We actually got into EMR through our pharmacy business. I'm actually a pharmacist by trade.

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Robert Gleeman: Ah.

Mike Patel: I was a Pre‑Med student and then because of health issues with my parents and needing to support the family, I switched majors and became a pharmacist. Then, we purchased our own pharmacy back in '97.

And, we developed software to automate our pharmacy because the software that was there is, you know, to do a simple task you had to do twenty clicks. I kept calling the software vendor to make changes, and eventually, it became a joke to them. So, I said, well, forget you guys. I'm going to go and develop my own software.

Robert Gleeman: And, when did you start Meditab?

Mike Patel: The initial development we started was back in '98, '99. The company was started sometime in early 2003, formally. Initially, we did all of the work through the corporation that owns the pharmacies. We developed our own pharmacy system to help our pharmacy become more efficient and to help us manage medications for patients that are in retirement homes.

Robert Gleeman: Now, you have a product that you call IMS, Intelligent Medical Software. This is your EMR and billing version of the software for a standard medical practice?

Mike Patel: Yes. IMS stands for Intelligent Medical Software. And, it is a complete package to allow you to run your medical office. It not just looks at EMR and scheduling and billing, but everything associated with a medical practice. And, that is the reason people love our software. It flows well, and everything that you need to do in an office, we have a module available that can handle that. We were probably the first company that I know of that had a completely integrated fax server with the product.

Robert Gleeman: Interesting.

Mike Patel: The fax is a very, very important piece that performs many tasks in a medical office. The IMS product actually can cater to multiple specialties. It is so deep. It's powered by about 800 tables in the back end.

Our current medical director's name is Dr. Guarav Tyagi. He actually has been instrumental in our template design. We have templates that cater to about 22 specialties. And, we can say we have probably great knowledge and expertise in about nine or 10 of them where we know we have a significant advantage over competitors in our market.

It has to be a complete solution because, otherwise, what we find is that, you know, if you have two or three products you're integrating, then, well, it's not my fault, it's their fault.

Robert Gleeman: One doctor said I only want one neck to strangle when he was talking about vendors.

Mike Patel: Yeah. That's right. That's the way it should be.

Robert Gleeman: I notice also that on your website are some very nice testimonials that go into very great detail. It sounds like you have a unique approach also to service after the sale.

Mike Patel: Yes. We strongly believe in service above all else. If you take care of a customer when they have a problem, that customer has no need to ever go look for another piece of software. And, they will remember that for life. Furthermore, they'll tell their friends about it.

Robert Gleeman: You talk about software as a form of medical instrument.

Mike Patel: It is. In fact, our software, it's more than a medical instrument; it's a necessity nowadays with the reimbursement levels as they are. And, a good software can make your whole office hum. It can make your whole office just flow beautifully.

Robert Gleeman: Who's this guy, T.J. Wilkinson? Why does he think you have the best software he's ever seen in his life?

Mike Patel: Am I allowed to have him answer that?

Robert Gleeman: Yeah.

T.J. Wilkinson: Hey, Robert.

Robert Gleeman: Hey, T.J. Do you work there? Are you an installer for them? What's your connection?

T.J. Wilkinson: I work for Medetron.

Robert Gleeman: Oh. OK.

T.J. Wilkinson: Gene Powers is our President. And, I came to the product through Gene installing training, implementing Medinotes. And, I just fell in love with the product.

Robert Gleeman: Well, your first post in which you said, "This is the best software I've ever seen in my whole life, impressed me so much that I looked at the website and I said, you know, it does look pretty good".

T.J. Wilkinson: [laughs] You know, Robert, every doctor that we show this to ends up loving it. I mean, everybody thinks it's phenomenal. It is, by far, the best put together software I've ever worked with. And, I've worked with a lot of software over my years, both in Pathology and Forensics, and then, in Medicine. And so, it includes everything. It's easy‑to‑use. It's intuitive. It just makes sense.

I mean, I won't name another product. But, I worked with another product. And, I end up telling the client, well, you know, it really doesn't work well this way, or we can't use this here. With IMS, and with the other related products, they work together. I don't have to struggle to make something work in an office.

Robert Gleeman: I like that approach because I don't like to struggle with my software. I'm an old guy. I have resisted computers. Give me a break.

T.J. Wilkinson: [laughs] Yeah. And, you know, a lot of times EMR software or Practice Management software makes you change your practice to fit the software. And, here we don't have to do that. It's flexible enough and configurable enough and adaptable to what the office is already doing. We don't have to re‑invent the wheel, and we don't have to make people crazy in the process.

Robert Gleeman: Now, if someone wants to call Medetron and have you come out and help them with this, what is the phone number over at Medetron?

T.J. Wilkinson: (415)824‑0600.

Robert Gleeman: And, who should they ask for over there?

T.J. Wilkinson: They can ask for me. That's fine. Or, they can ask for Gene Powers, our President.

Robert Gleeman: OK. OK. Well, T.J., I really appreciate your help in getting this put together.

T.J. Wilkinson: Oh, you're very welcome.

Robert Gleeman: And, I hope that what we can do is bring this software to the attention of our readers as a real contender that they need to look at.

T.J. Wilkinson: Yes.

Robert Gleeman: And, if we can do that, I will have been successful.

T.J. Wilkinson: Fantastic. You might want to mention, just off the record, between us, you may want to mention to Mark Anderson that you've done this. I think Mark looked at it recently and was very impressed.

Robert Gleeman: I will do that.

T.J. Wilkinson: Good.

Robert Gleeman: And, that says a lot because Mark is, to me, the single most knowledgeable guy on EMR in the world.

T.J. Wilkinson: Yes, he is. Yes, he is.

Robert Gleeman: And, if he's impressed, everybody should look at this.

T.J. Wilkinson: Absolutely.

Robert Gleeman: It's a must look‑at.

T.J. Wilkinson: Well, thank you, Robert. I really appreciate you taking the time to do this.

Robert Gleeman: Well, thank you, T.J. and, thanks, Mike.

Mike Patel: Ciao.

Robert Gleeman: And, we'll get this out just as soon as we can. Like I said, we only needed ten minutes. My job is so hard, so hard.

T.J. Wilkinson: I understand.

Robert Gleeman: OK. Thanks, again.

T.J. Wilkinson: Thank you, sir.

T.J. Wilkinson: Bye‑bye.

Mike Patel: Ciao.

Interview with Bruce Hrenyo, President, Tangible Solutions, Inc. VAR for e-MDs

2008-01-18T04:21:00Z

Our interview is presented as both a YouTube presentation and an outsourced transcription of our discussion. To listen to our interview please click the Play button on the YouTube movie displayed below.

Robert Gleeman: This is Robert Gleeman with emrupdate. We're talking today with Bruce Hrenyo. Bruce Hrenyo is the President of Tangible Solutions. Tangible is a VAR, a value‑added reseller, for e‑MDs.

Bruce, when did you start selling e‑MDs?

Bruce Hrenyo: We started with e‑MDs in 1998 or so. We were actually e‑MDs' first VAR. We went out on a hunt for products to represent and capabilities that were interesting to us. We did a fairly extensive list and cross‑analysis with a number of the products that were available at that time. We came across e‑MDs and started using their product and reselling their product.

Robert: Why did you pick them?

Bruce: We wanted to work with a young, vibrant company, and at that point it was actually version 1.04 of their product. We were also starting, and we believed in a technology called ASP, and we created a technology called "Happe: Hosted Application Environment" We wanted to work with a company that would allow us to have a diversity of delivery mechanisms for practices. So, they make available the traditional LAN‑based installation as well as, through Happe, we have an ASP solution. (continued after the YouTube movie)

(Please visit the site to view this media)

We look at a VAR as a third part of the cycles. When you deal with a vendor, you have an opportunity to look at other products that maybe a software vendor does not provide. And again, we look at it as a solution when we present an EMR product to a practice.

We start with: are they satisfied and interested in e‑MDs as a solution series? And then from there we actually start to tailor into a more diverse solution to solve their problems, whether that is a LAN‑based installation or a hosted‑based application. As well as we bolt on other technology: we do automated check‑in kiosk systems, electronic claims, electronic eligibility, that kind of stuff.

Robert: We have come to know that EMR is a very service‑intensive operation. Do you have a lot of service people that go out there in the field with the customers?

Bruce: Absolutely, and the way we actually deploy our trainers, our trainers are actually in the field. So we use a lot of the same technology that we would put into doctor's offices: VoIP, Voiceover IP phone systems, as well as other types of technologies, remote access, remote control and so on.

We actually place our trainers out in the field. Though we are based in Charlotte, NC, we have trainers up towards the Virginia border line, we have trainers in Ashville, we have one down in Columbia, South Carolina. Our accountant is based out of Greensboro, North Carolina.

Robert: Why do the e‑MDs customers seem to be so happy?

Bruce: I think e‑MDs itself has a very good product, a very solid product. With e‑MDs embracing VARs out in the field, we're able to be closer to the individual problem so if a problem does arise we can actually get in our car and drive and visit the customer. We also have local training centers. That just gives us an opportunity to work more closely with the individual providers, help them develop templates, help them develop business workflows.

We believe it's more than just, "Here's a product and work with it." You have to try to embrace that product, you need to try to extend the features of that product into your practice and that's where we feel VARs step up to the plate differently than directly software sellers.

E‑MDs is a great company, {I've been) with them a long time. In our case, they're based out of Austin, Texas. They may or may not know the nuances of Charlotte, North Carolina, or a rural community here in the Carolinas where we would know those rules and nuances, how to work through issues, local technical issues.

Robert: e‑MDs supplies a lot of medical content in the form of 800 different templates. Do you also have access to those templates?

Bruce: Absolutely, e‑MDs ships the majority of those templates with the product. They also have newsgroups in which they have some of those templates, provided on those news forums, as well as we actually have a couple of providers that we work with that will help some of our other provider customers develop templates for them. We do have a tremendous amount of flexibility to make the product work with each of the providers within a practice and then create an environment that allows them to follow through with that workflow.

Robert: Speak directly, heart‑to‑heart, to those 6,000 doctors out there and tell them why they should call you.

Bruce: We find providing technology, providing solutions to practices, an important help for them and that's what we're here to do. We're here to help them go through technology. Very often I do the same thing for my provider, I go to my internal medicine doctors and let them help me understand medicine. We do the same thing on technology, we're here to provide a solution.

I have a quick story of ‑‑ sometimes the solution doesn't need to be fancy. We had a practice that, when we brought them on to an EMR, had some difficulty routing the patients through the practice. We didn't invent some super‑technology carrier or any of that type of stuff. What we wound up doing was we made a little grease eraser board. We laminated some sheets so the provider circled the provider's name, "follow up in two weeks," and handed that to the patient.

Sometimes as simple as a piece of paper helped route those patients through the practice. So solutions don't need to be technology, they don't need to be expensive, they don't need to be fancy. Sometimes they're as simple as a piece of paper.

So that's what we position ourselves to do, is providing solutions for practices and helping them navigate and manage and take a lot of the technology pizzazz out of it and try and help them understand it.

The overwhelming majority of technology that we offer to practices, the solution we offer to practices, is technology that comes from providers. They'd ask us to look into a set of technology and so we use that opportunity to research it, see how it would fit, make sure it works, understand it and then we move that forward with other practices.

Robert: We were talking today to Bruce Hrenyo from Tangible Solutions. Bruce, thank you very much for being with us today.

Bruce: Thank you! I appreciate this opportunity.

Interview with Dan Montzka MD, President IntelleMED, Inc.-- EMR for Ophthalmology

2007-12-21T04:13:00Z

Today I'm talking with Dan Montzka, a board-certified practicing ophthalmologist, founder and president of IntelleMED.

This presentation is published below as a YouTube podcast but is also available for download as an MP3 from this link. To listen to our interview, please click the Play button on the YouTube presentation below.

I start by asking how Dan got into this field. He's not a programmer. Dan left a large multi-speciality practice and started a new practice on his own. He was Interested in efficiency of using an EMR, but didn't feel the current offerings were suitable for the things he was trying to do in practice.

IntelleMED is based on one of the Microsoft Office applications called InfoPath, used generally for the generation of templates. They got so far using templates, but eventually called in some programming to complete their application. Microsoft Infopath stores everything in a standards-based XML format, but eventually you need some database to give you a data-centric EMR. IntelleMED use the Microsoft SQL Server database within some of its modules.

(Please visit the site to view this media)

IntelleMED is used as an in-office Server application but could quite easily move to and ASP application.

What drew me to IntelliDRAW was the use of lots of color and dots --- a bit like a Christmas Tree. I ask why an ophthalmologist would need to draw?

Ophthalmologists document using drawings and diagrams -- this is a really time consuming thing that they do.

It can take several minutes for a detailed diagram. There may be a small amount of revenue from the documentation, but they really want an accurate description of what's happening for the patient. When getting started Dan noticed big limitations in existing drawing packages.

Ophthalmologists need a very detailed and specific drawing in a short amount of time. This is what IntelleDRAW provides.

The IntellMED Charting system is granular in nature. What does IntelliMED mean by granular?

Data is specific. Location, severity or status of a leision can be documented specifically. Individual findings -- thay can then be edited.
Especially in ophthalmology and retina patients are older and present with multiple abnormalities. An ophthalmologist finds that a granular system is far better.

I ask about the Smart Pick-List for charting findings. Dan explains that it's difficult to have a template created that was just "disease specific". Instead they use a template that is more "problem-list" specific,using a unique set of smart pick-lists for any patient.

I ask how was the response to the announcement of IntelliDRAW at this past meeting of the American Academy of Ophthalmology. Dan explains "Really kind of exciting. Everyone who saw it, came back for a second look with their partners or with other contacts. This was really how they wanted to do drawings compared to other Icon based drawings. This is quite different from the usual Drag-and-Drop onto a drawing backgrounds. You're spending more time looking for the right icon, than drawing. An IntelleDRAW diagram is created in layers from your documentation. Basicallty you press a button and the system gives you a proposed drawingt which is then edited by layer.

The IntelleMED products are:

IntelleCHART
IntelleVIEW
IntelleFILE
IntelleDRAW

Do Doctors typically use all the functions together? Some have their own viewing packages which they can work with separately. What we provide for is that very detailed examination done very quickly.

I ask why is Ophthalmology so different from other types medicine? Patients are older, with multiple issues and a different focus. Can this product be demonstrated over the internet?

IntelleMED recommends a tablet with active digitizer screen for the best experience for detailed drawings. I was "drawn" to the color -- must be the holiday season. Dan explains that they're also using Microsoft "Ink" technology. This gives a very smooth drawing experience unlike the grainy experience of older drawing systems.

What is Dan's key message? Take a look at this system -- The most important thing for an Ophthalmologist is how this will it affect their clinical efficiency. They are very busy. They need to continue to see same number of patients they were seeing when just using paper. They can start running IntelleMED software very quickly and continue to practice medicine wihout delay.

Thank you Dan Montzka M.D., President and founder of IntelleMED.

You can download this interview as an MP3 from this link.

Interview with Rich Steinle, CEO of PracticeIT -- Doctors' Bill of Rights

2007-12-04T12:08:00Z

Today I'm talking with Rich Steinle, CEO of Practice IT head-quartered in Austin, TX.

To listen to our discussion please scroll down to the YouTube frame and click Play.
You can also listen to this interview directly upon YouTube here.

The following is a general abstract from parts of the interview.

Practice IT are a Medical Technology and Services company -- serving MDs with innovative technology and they say, unparallel customer support. They provide both their own home-grown & developed EMR package and also provide Diagnostic technmologies with some exclusive partnerships.

Rich Steinle says that they really do focus completely on the Doctor.

I ask Richard how does PracticeIT reach the Doctors. Rich explains that they have a multi-pronged strategy. First with a direct sales force actually visiting and demonstrating software in their offices. Our sales representatives are on the road in the field in the offices. PracticeIT can provide dedicated infrastructure if there isn't one already in place, or use a Doctors existing resources, provided they're good enough. Additionally dedicated servers at our data-center provide secure redundant EMR data backup.

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Security of data - backup is key to the Docs data. Access form home/office and remotely BUT with security. Data Center is redundant.

What is the Doctors Bill of Rights -- formed in co. philosophy. We're not new to this market, but can bring a new level of service to the market. Don't beleive Docs need to become technologist. Puts down in bullet form what Docs should expect from Practice IT.

•    Non-invasive technology that lets you focus on patient care.
•    Exceptional personal service from a vendor you know and trust.
•    Features you need at a price your practice can afford.
•    Code and bill accurately for your services.
•    Efficiently and securely collect, store and measure your data to prove tangible results.

What about hand-holding? We have a physician services team dedicated to the Doctor. Personal installs with the Doctors, training and there as people with names known by the customer for additional on-line help -- remote assistance or follow-up visits.

Respect for Doctors -- Doctors on staff.

Service to the customer is the main thing. If you look at the landscape it is littered with products and services. Doctors don't lack for options or services. But they are underserviced by a personal approach to service. The EMR decision is a big thing. We can implement this right in the way we've designed this more and more doctors can take use of this technology. We believe they have a right to practice as Doctors as they always have -- but with the EMR tools to automate what they're doing.

You can also listen to this interview directly upon YouTube here.

Robert Gleeman talks with Divan Da've, CEO of OmniMD about their breadth of EMR offerings

2007-09-18T04:20:00Z

Divan Da've* CEO, OmniMD believes that the EMR vendor should do it all. EMR, Patient Management, Document storage, Prescriptions, Patient Portal and more, with these applications supported across a range of devices including PDA, Tablet PC, local area network, wireless and Internet.

* Correctly pronounced as "Divahn Dahvey"

Talking with Divan Da've this philosophy comes across along with a strong long-term committment to EMR.

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Divan Da've is also a fairly prolific contributor to articles and other interviews.

Try a quick Google search here to read his other articles.

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