Enough

Do you have to go Paris or the Islands or somewhere exotic to get away?
Of course not!
A weekend with your family in an inexpensive hotel in a nice locale within several hours drive is enough to re-charge and re-energize.
And as a busy, self-employed practitioner, this type of get-away won't hurt the practice either.
I'd rather do 10 of these mini-VKs than take 1 long but exotic trip.
Just me and perhaps just for now, but the truth.
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Nice day

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An evening out with the girls

Nice break from my EMR hassles, etc
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Not bad daddy

My name inscribed in a plaque.
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Road trip with the girls.

My father daughter trip begins
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Make good use of your time

Using time wisely has become more important than ever.
EMRs help here, as they make the most out your precious minutes with a patient.
Tablet PCs can save time as well, since you can use them as both paper and computer.
Electronic faxing saves time by preventing printing problems and scanning issues.
Mobile devices allow me to blog while waisting valuable time at Costco.
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Why now?

Why choose the EMR now? Well, why make any decision at any point in time?
Because I identified problems that needed solving.
Here were my problems:

Too much scanning.
Too difficult to send correspondence
Too many refill and rx issues
Too many documentation problems
Too many scheduling mishaps
Too many remote access disruptions
Too much effort with back-up
Too much paper
Too much effort
Too much work
Too much wasted time
Not enough reward

Yes, it was time.
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A new generation of bloggers

I have some competition now.
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MY FIFTH EMPLOYEE

I currently employ 4 people, including myself.  I have 2 MA's and a part time biller.  All 4 of us make more than $600 per month.  My fifth employee is my EMR system.  It cost me $600 per month, +/- a few.

My fifth employee works 24/7 and never takes a sick day or personal day.

My fifth employee never forgets to do what I ask of it.

My fifth employee doe not make mistakes.

My fifth employee is very organized.

My fifth employee can write prescriptions.

My fifth employee can file labs efficiently. . .and retrieve them with equal efficiency.

My fifth employee can submit claims. . .at 2AM if I ask it to.

My fifth employee can generate letters to referring doctors. . .and deliver them. . .24/7.

My fifth employee is a great employee, my electric one.

Even at the hefty price tag I paid for it, my EMR when viewed as a fifth employee is cheap. . .very cheap.

Here's the thing: people expensive/robots cheap.

That is a good way tolook at an EMR investment.

Email back-up

I just had to do a massive re install of the OS on my Tablet PC. I do back up daily so I lost nothing, but I do have a warning regarding Outlook back-up. You need to take an extra step to insure that all emails are saved. I just hit the folders I want saved, hit ctrl A, save as a text file onto you back-up drive.
Then all emails are easily restorable as text files than can easily be read.

In back-up, it is the ability to restore that matters.
Good luck.
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Mobile Ideas

Sometimes, in fact often, I find myself in car with sleeping child. There, alone and in piece and quiet, I often come up with my best ideas. Many blog posts, many practice decisions, even iLabTQM, my new CLIA Compliance Solution, have been launched from my Honda, with sleeping child aback.
I always keep pen and paper handy for such occassions, though now I have a Blackberry, so when idea comes, I compose it into an email or MMS and blast it off.
Makes for a good use of time--my alone time.
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"For your convenience. . ." Who are they kidding?

Beware when a company changes its operations "for your convenience. . ."  For your convenience actually means for their convenience.  While you may be helped by the change, that is mere coincidence.  The change in operations was made for cost savings. . .or increased profit, etc.  But certainly, it was not made primarily for your betterment.

When the customer service department notifies you that service queries must now be made on-line rather than by phone--"for your convenience"--it probably means that you'll have to wait longer to get help.

When statements can be sent by email, rather than mail, the company benefits by saving money on postage and envelopes.

Just my cynical observation made for your convenience.

In a rough economy, give patients value

In this challenging and down economy where insurance companies and Medicare attempt to remain viable by raising premiums and co-pays, patients may balk at having to come to the office merely to "discuss lab results."  Now I know as well as you do that the cognitive aspects of medicine are important, valuable, and worthy of pay.  Even the insurance companies recognize this fact.  But patients, on the other hand, get pissed off when they are asked to pony up $50 when you don't "do anything."  While I disagree with the patients on this one, I do understand their gripe.  As a result, I try to offer something "of value" to them on every visit.

You may want to try the following: have patients come in to discuss results

• . . .and have a repeat physical exam.
• . . .and have a urine culture
• . . .and have a blood draw
• . . .and have a ultrasound
• . . .and review radiologic studies in their presence
• . . .and draw diagrams for them
• . . .and complete forms

etc.

Just something I've figured out over the years.

From Idea to Implementation: 5 Steps

My friend Steve once told me, "ideas are cheap."   He was right.  They are cheap.  The real challenge is taking an idea from concept phase to market place, or FROM IDEA TO IMPLEMENTATION.  After you have come up with the idea or have identified a problem that needs solving, here's how to begin.

1. Commit the idea to paper.  This gives it life.
2. Develop a revenue model around the concept, ie subscription, advertising, affiliate, etc.  If the idea survives this test, proceed to step 3.
3. Write a business plan.  This converts the idea, which is really just a 1 cell embryo, into a 6 week old fetus: you may not tell anyone else about it, but you are starting to get excited.
4. Do research: Nothing fancy needed here, but some gentle field research, Google searches, informal focus groups may let you know that the fetus can develop into a baby or perhaps it can not.  But you'll discover it's fate before you invest more time and money into the project.
5. Speck-it out: Build a mock-up version of the business.  In-expensive software can help here, or pen and paper works as well.  Be as detailed as possible.  Re-visit, re-work, & re-imagine the project often.  Try to poke holes into it.  Pick it apart.  Because the next step is either. . .
6. Abandon or commit.
   

Good luck with your endeavor.

My respite.

In case you have not noticed, I've been inactive for the past few weeks on the blog. Lots have been going on, good stuff, just lots-o-it.

I am in the midst of an EMR conversion and this eats up an enormous amount of time and energy.

I have been very busy in the office, knock on wood.

Insurance companies, in general, seemed to have slowed down their disbursements to me. From comments on various list-serves, this seems to be a national trend. BASTARDS! But working claims has become a team approach.

I have developed software that automates and facilitates the quality assurance and CLIA compliance processes in my lab. Since it has worked so well in my office, I have decided to turn it into a business. Beta-testing will start soon for interested practices. Very time consuming indeed, and exciting. Here is the link: www.ilabtqm.org.

I'll start posting again a bit more frequently soon.

Again, sorry for the respite.

Sad

This is a mother of 2 girls the same age of 2 of my 3 kids. She frequents a bread line in South Florida.

From the NYTimes:

Megan Brown, standing in line with her well-dressed daughters, Kayley, 2, and
Sydney, 4, had come because she feared the worst. Her husband still had his job,
she said, “but things are getting more and more tight.”

Scary and sad times indeed.

How an EMR changes you and your practice forever.

Forget everything about how you used to do things.  Just let it go!  When you adopt a high-end EMR product, you'll find that business as usual is over, and forever. 

• Workflow: Old way: front desk staff checks in patients, then doc takes the entire history.  New way: patients can check themselves in and staff takes the majority of the history, such as the PMH, Allergies, Social History etc.  Doc reviews, completes, and cognates.
  
• Back-end: Old way: complete charge sheet, give it to back end staff, they enter charges, submit claim.  New way: after the encounter, doc completes the note, signs, and voila, off it goes to the clearinghouse.  Billing staff now freed up to "work" the claims.
• Scheduling: Old way: patients call, overload phone lines, and staff assists in booking while waiting room fills up.  New way: patients book themselves on-line, enter their own information, doctors phone lines freed up, staff freed up.
  
• Precriptions: Old way: scribble, give to patient, often gets lost or handwriting issues, leads to call backs, refills, torture.  New way: click on favorites, click on med, click on pharmacy, click.
• Coding: Old way: document as much as you can given time and hand-cramping restraints, stay within the bell curve for your specialty, then hope you don't get audited.  new way: predesign your templates with appropriate level of E&M coding, see patient, hit enter, next.
• Lab and study tracking: Old way: give patients requisitions and hope they go and hope you get lab and hope lab is filed correctly and hope you don't miss anything bad.  New way: select tests from check boxes in template, hit enter, system flags non-compliant patients, all results come to you automatically, electronically, effortlessly, and if you want it, graphically.
• Practice patterns: Old way: "this is how I do it."  New way: pre-program best practice guidelines from professional organizations into your templates, then all appropriate tests and studies are orderd automatically, effortlessly.
• Coordination of care: Old way: dictate, wait for transcription, mail.  Call doc, wait on hold, disturb.  New way: select letter template, recipient, hit enter.

Ahhhhhhhh!

The IU.

Are we next?

Employment lawyers have seen a sizable increase in wrongful discharge claims.  Are we next?

I've always thought so.  It seems to me that claims of all sorts would rise during tough economic times.  For doctors, I think this is especially true.  Any adverse outcome that results in lost time from work or out of pocket expenses could quickly change a good doctor-patient relationship into a bad one and result in a claim of medical negligence.

I'm not sure what to do about, other than make sure you dot your "i's", cross your "t's", and make every effort possible to manage risk in the office.  Perhaps now is not the time to increase risk by adopting new techniques and procedures in the office.

I don't know.  Scary stuff!

The hiddden costs of any marketing campaign

Marketers are very quick to sell you on the upside of any campaign, whether it is TV, radio, print, email, or direct mail.  Skilled marketing companies can even supply you with data on conversion and response rates and how much return on investment you can expect.  But beware of the hidden side to any marketing modality.

The TURN OFF FACTOR!

Newton's third law of motion states that for any action there must be an equal but opposite reaction.  While in marketing, the opposite-than-intended reaction may not be equal, it is present and you ought to be aware of it.  Lets use a mailing as our example.

Let's say you send 2000 newsletters to your established patients.  Conservatively you can hope for the following:

• Cost of the mailing ~$2500
• 1% positive response rate, max = 20 patients who call to come in and be seen
  
• Each encounter  = $150 = ROI of 120% or the campaign paid for itself + $500.

Sounds good, right?

Now lets factor in the turn off factor.

• Of the 2000 mailings, you annoyed 1% 20 patients
• 20-60 patients x $150 = $3000 in lost revenue for those patients who decide to hopefully just leave you.
• Factor in an additional small percentage of really mean people who will use the mailing as a reminder to bad-mouth you to others.
  

Obviously, this is an extreme example, but the turn off factor is probably in the 0.1 percent range, or 2 patients out of 2000 = $300 plus any additional bad-mouthing damage that they may do.

Just think about all the possible outcomes before you do a mailing, or any other brand of unsolicited, in-your face, type marketing campaigns.

Good luck,

Dr S

Clueless? Design the Front End First

Let's say you wanted to start a web-based business but did not have any web design, programing or software engineering experience, you might think that it would be impossible to proceed with your plan.

You'd be wrong.

Using simple and inexpensive software, such as Balsamiq or even MS Publisher, you can actually build your site from the front end first, ie from the experience of the user. Then, you just have to find a coder to build you the site and then find someway to pay for it all.

If you are going into a new, solo medical practice, you can adopt this type of backwards planning strategy to achieve your ultimate goal even if you lack the knowledge to see the all the details involved in the project.

For example, perhaps you want to leave a group practice to start your own one, but have no experience with the business aspects of medical practice, you can use your knowledge of how you want to experience life in your practice and then step by step find out how to accomplish the seeming impossible. You may know that you want to see 20 patients a day, take insurance, do in-office procedures, major surgery in the hospital, and have a lab. Using this knowledge, you can back-step the route to the goal.

This strategy takes some practice, but you'll be amazed at what can be accomplished by using it.

Good luck and let me know how it goes.

The IU.