I get it, I think.

I think I finally "get" Twitter.  Or at least I figured how I plan to use this seemingly inane service that millions love.

Twitter is best used when the tweeter draws attention toward someone else, rather than himself.

The "I'm at Starbucks" tweet is boring and useless.  On the other hand, the "check at this new gadget" tweet, well that might be interesting.

As in any form of marketing, the best type places attention on the other person, rather than the marketer himself.

Better to be "how can I help you?" than "how can you help me?"

New Years Resolutions

Try these on for size:

1: Go E.H.R.
2: Improve your E.H.R.
3: Start PQRI
4: Decipher "meaningful use"
5: See more patients or...
6: See less patients
7: Learn 10 new codes
8: Get rid of 1 piece of paper
9: Do away with 1 process
10: Write a book

Happy New Year

Dr S

Sent via BlackBerry by AT&T

Miniature Circus

If the Medicare cuts go through, I am going to run away and join the miniature circus.
Sent via BlackBerry by AT&T

Come on, come out, Sun.

Sent via BlackBerry by AT&T

Using an EMR to Solve Problems

If someone came to you with a solution to 3 out of the 5 biggest problems you face, you would probably take it--or at least listen to their proposal, right?

Imagine if someone said to you, "you know that persistent problem you have with your filing system, I found the perfect solution and you'll never have to deal with that again."  I don't know, I'd be all ears.

Every doctor has problems.  Filing and retrieving, lab tracking, order tracking, prescription refills, handwriting issues, messaging handling; these just name a few.   I certainly had my issues.  Many of them are now past tense issues.

Prescription issues:  99% solved.  On rare occasion I forget to initial a narcotic script or my rx printer malfunctions.


Message handling:  100% solved.


Handwriting issues: bye bye!


Filing/retrieving:  see ya.


Lab tracking: 90% better.  I am still learning my EMR's functionality.


I still have problems, but just not these problems.


A good thing.

This Jewish guy likes Christmas.

Sent via BlackBerry by AT&T

Early Praise for My Book, Suddenly Solo

Rich's book is excellent I am going to have my office manager read it too.  Nice to codify philosophy of self made "man". . .

Dr A.G.
Urologist  NY, NY

You can get your copy FREE.  Just click the cover.

An Excerpt from Suddenly Solo

Imagine being safely ensconced in group practice one day, just going through the motions, but nonetheless enjoying your day—talking with colleagues, consulting with patients, maybe even enjoying lunch, driving home, talking over your day with a friend or your spouse, and then walking into work the next morning, only to find yourself out of a job—fired.
Or, if that doesn’t gut you enough, imagine coming to work one day to find that not only do your keys mysteriously no longer work, but a security guard bars you from entering the building, where all your files are locked away.
Here’s another dream scenario: Imagine returning from a long-overdue, much-anticipated, relaxing vacation to find that your partner has conspired with another and has effectively stolen your practice. . .

. . . . . . . . . . . . .

If you want to read more, just click the cover on the sidebar and register for your free e-book copy.

And good luck!

Dr Schoor

My Book, Suddenly Solo, is finally ready for publication

Three years in the making, perhaps even more.

And you can have it free, for a limited time.

Just complete the following webform and the e-book version of Sudddenly Solo: A Physician's Guide to Surviving & Thriving in Your Own Medical Practice will be emailed to you.

I hope you enjoy it!

Dr Schoor

Happy Holidays

Make a Smilebox greeting

Not Everyone Needs High Tech Toys

Sometimes you can't beat the old fashion.
Sent via BlackBerry by AT&T

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

My favorite American tradition.

Happy Halloween.
Sent via BlackBerry by AT&T

How to document an encounter quickly with an EMR

Electronic medical records have many advantages over traditional pen and paper charts. Speed of documentation, however, is not one of them. I have been live now on my high end electronic health record for 6 months. My first encounter on the system took place in February 2009 and took me 45 minutes to document on the system. Obviously, I would need to improve upon that. Now I do things differently, more efficiently. Here is my work flow:

1. Schedule patient, office staff gets some clinical information
2. Appropriate clinical templates are pre-loaded by me or staff into notes prior to patient arrival
3. I review the templates and pre-order labs, studies, and prescriptions as I see fit
4. When patient arrives, I perform the encounter and do my doctoring
5. I then determine if pre-ordered tests and prescriptions are still appropriate
6. Finally I complete the documentation, sign note, and on to the next patient.

The entire process now takes under 5 minutes and is much less stressful.

When you get an EMR, you must change your work processes to adapt.

Are meetings worthwhile?

As reimbursements continue to decline for many of us and we are forced to remain in the office longer and longer to make up the lost income, our attendance in meetings has taken a back seat in importance. This is a shame and you may wish to re-think this cost-cutting strategy.

Meetings are very, very important. You'd be better off cutting out some othe expense.

Meetings allow attendees to re-charge their batteries and return to the office energized and more productive than ever. Only through meeting with colleagues face to face can doctors forge new relationships that are important for networking and business development. While we may be able to learn new techniques and advances in our field through online CME courses, we learn best in person where the dialogue is 2 way and we have access to non-verbal communication.

Meetings are not cheap. Flights, hotel, registration, and time away add up to thoudands of dollars. However, if you choose your meeting wisely, increased revenue will offet the costs many times over. All it takes is learning one new CPT code or one new modifier or a new profitable procedure and you will payed back in triplicate, at least.

I just think this is not an option for cost cutting.

Wow, you can bill Medicare for waiting room magazines

From 2 posts on a listserve to which I subscribe:

" There are codes for magazine loss/replacement:
CPT: 9999a- replacement of magazine, identical issue
9999b- replacement of magazine, similar topic matter
J codes: 80% of magazine cost"

Also, since the governement is so interested in our education, here are some other codes you can use:

"Recent governmental efforts to encourage literacy among the poplus has lead to CMS's request for physician offices to voluntarily report, via PQRI, on appropriate utilization of magazines and reception area reading materials. Qualifying providers will be eligible for a 2% bonus of their annual CMS billings. These G-codes for PQRI measure 9999 are: G9990 - Educationally meaningful magazine provided at reception area G9991 - No educationally meaningful magazines provided at reception area G9992 - Some or all educationally meaningful magazines made available were lost due to theft or damage Eligible providers must successfully report on at least 80% of pts on Medicare seen in 2009 to qualify. The exact definition of educationally meaningful is still being debated, and won't be released until early December 2009."

I believe that most of this information came out on April 1st. I am not sure I recommended trying these codes just yet.

Hat tip to http://www.sunriseurology.com/ and Dr Ernie Sussman, famed urologist in Las Vegas. Hope you enjoyed.