Not Everyone Needs High Tech Toys

Sometimes you can't beat the old fashion.
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My presentation milestone

I am a big believer in software as a service, despite its pitfalls. Today I gave a presentation at my hospital's tumor board. In the past, I'd have had to bring either my laptop or a thumb drive with powerpoint talk and ope that everything would sync ok. This time, I just had to make sure they had a computer with internet access. They supplied that, no problem. I just brought a url. Worked great.



Gotto love technology

EHR is not a panacea, Mr President

From the AUA Daily Scope

"Study finds little benefit to date in electronic patient records.
The New York Times (11/16, B3, Lohr) reports that a study to be presented Nov. 16 at a medical conference "comparing 3,000 hospitals at various stages in the adoption of computerized health records has found little difference in the cost and quality of care." Researchers from the Harvard School of Public Health conducted "a follow-on study to a survey of hospitals' adoption of electronic health records, published this year and financed by the federal government." The authors found that "differences...were 'really, really marginal,'" and suggested that "government policies should focus on helping physicians, hospitals, and the public health system use the technology more effectively." "

Frankly, I am not the least bit surprised.

The IU

My chief resident: a famous LA urologist on MTV

The Hills - MTV Shows

Hat tip to Dr Adam Weiser

A death spiral in evolution

It is truly fascinating to witness a corporate death spiral firsthand.  Here's how one just unfolded in my presence.

• Company A, a software as a service (SAS) solution lands big client, Company B, an EMR company.
• The arrangement flourishes.

In business--and life--the only constant is change.  In this case change produced:

• Increase in demand for company B's SAS solution
• Company A needs to invest in infrastructure to support Company B's plans.

Credit Crunch or bad Management?

• Company A unable or unwilling to accomodate Company B's plans
• Company B finds SAS vendor that will

The death spiral begins.

• Company B signs with Company C, the new SAS provider
• Company A makes lay offs of technical employees
• Service declines at Company A
• Company B gets tons of complaints
• Company B pulls remaining clients from Company A
• Company A has problems.

Wow!

Could this have been avoided by Company A.  In this economy, who knows?  Probably not.  I wish them luck.

Dr Schoor

Where an EMR helps and hinders in medical practice

EMR are very useful tools, just not for everything.  If you think about about all the processes that take place in your medical office from the moment a person calls to book an appointment to the moment you get paid, you can determine where the EMR will help and where it will hinder.  Here are some places I think these programs help.

• Scheduling
• Prescribing
• E&M Coding
• Charge Entry
• Claim Submission
• Payment Posting
• Acounting
  
• Auditing
• Ordering
• Document Management
• Clinical Trend Analysis
• Coordination of Care
• Patient Compliance
  
• Communication
• Information Flow
• Documentation*

Of course, not all processes are streamlined with an EMR.  The main example of this, and perhaps the only example, is the physician's encounter.  It takes longer for the doctor to document a patient encounter with an EMR.  And the doctor has to expend more effort to document the encounter.  Both the effort and time required to document improve over time, however.

Also, EMR generated notes are more cumbersome to read, which can make it more difficult for the doctor to get at the "essence" of his/her prior encounter.  Of course, this can overcome by adding memory joggers into the document.

On the balance, EMRs are improvements over business as usual for the small independent medical practice.

Dr Schoor