The End of an Era

I disconnected the last of my remaining VONAGE lines today, the phone that sat in my house and served as an office line, just one that happended to be in my house.

It feels a bit sad, nostalgic almost.  While VONAGE was the source of much of my telecom pain in the early and not-so-early days of my fledgling urology practice, it was VONAGE's then avant-guard service that enabled me to grow in those first critical months cheaply and mobily.

In many ways, it was VONAGE that put me on the map.  And for that, I thank them.

Ultimately, I outgrow its capabilities, however.

For the past few months, as I have been looking to cut cost whereever possible, VONAGE was always near the chopping block, but the off-site line still served a function, even though improvements in cell phone reliablity  at my house enabled me to make and receive calls from almost any room in my house.

Still, I held a special place in my heart for this little phone company that could, silly as it seems.

Then my VONAGE router died--just went kerplunk--and that was the catalyst.

Several minutes ago, I called and canceled my service.

Fairwell old friend.

Dr Schoor

Dwindling Down My Paper Usage

I am down to two!  Pieces of paper that is.  Everything else is the glorious e.

Patient records--electronic

Radiology reports--electronic only

Lab reports--electronic only

Patient intake & demographic form--electronic (actually, I don't even have one.  I got rid of it.)

HIPAA acknowledgement form--electronic, signature and all!

Consents--electronic

Patient statements--electronic.  They are actually mailed on paper, just not be me or my staff.

ABN (Assigment of benefits) consent form--you guessed it, electronic.

That is it.

So what is still paper?

We still send claims for secondary insurance by paper.

My biller insists on continuing to use paper encounter forms.  Alright.  If it ain't broke. . .

Dr Schoor

Unintended Email Consequence

My staff has been getting email addresses from patients.  Over the past few months, they collected 212 emails--not too shabby.  Thanks guys!

Yesterday I uploaded the email addresses to my email management site and sent the patients a confirmation email (I don;t want to be a spammer, so the patients must opt-in again to confirm they wish to be on my email list).

Most people have opted in, but what I did not expect was the number of emails from patients regarding billing issues.

It seems I have awakened a sleeping dog.

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

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Miniature Circus

If the Medicare cuts go through, I am going to run away and join the miniature circus.
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Come on, come out, Sun.

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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.

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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.
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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

My favorite American tradition.

Happy Halloween.
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