Doctors, protect yourself from bad technology investments

It would be disingenuous of us at SavvyDoc, to champion the need for further adoption of health care IT and not understand that with any new technology there will be unscrupulous providers of bad technology. I recently came across a great resource for doctors who are having issues with their electronic medical record systems or are looking to implement a system. Doctors in peril is a non-profit organization that is looking to help protect doctors from bad IT investments. There is some useful information on current companies the organization is fighting legal battles against, but there is also a brief breakdown on how to protect your IT investment, which is VERY good. For those of us looking to implement IT solutions into health care these bad technologies or bad companies only slow the progress of a blossoming field.  Especially with SavvyDoc where we have created a solution particularly useful for smaller practices, which are at greater risk of these predatory selling practices, we want the buyer to make informed and smart decisions on IT solutions for their practice.

Updates

Recovering from a little Spring flu but of course we have still been keeping up with some of the most interesting stories regarding the intersection of health care and technology. I want to briefly recap some previous posts with updated information.

Your Dr. Nurse will see you now…

We discussed the primary care crisis and the interesting solution of creating a doctor of nursing practice degree to fill the void of primary care physicians. I still think this is a reasonable idea if managed in the correct way so that medical doctors are still readily available for consultation when more complicated patients require care. My biggest issue with the DNP was that as a M.D. doctor it would be ideal if there were a better title for the DNP so as not to cause patient confusion. To update there was an interesting blog on pharmacists increasing their role in primary care. Having worked with an excellent pharmD in the past, I think this is a great idea. A pharmacist can be a great resource for patients when it comes to questions about medications and I argue could manage small medication adjustments just as well as physicians. The additional advantage comes in that actively involved pharmacists would be better equipped to help prevent medication errors.

Fears over patient privacy

There was a recent breach at the NIH where patient records were stolen from a doctor’s laptop. I argued that though these crimes of health care related information are serious they tend to be used as an excuse for not implementing electronic medical records (EMR) or other web based health care tools. My argument against limiting implementation of EMR’s is based on my experiences of paper based records being the least secure method conceivable for maintaining patient privacy. Having worked in a hospital with EMR’s and one without, the loose paper trail and privacy breaches when EMR’s are not implemented are atrocious. A colleague of mine brought up a great point one time, when a patient is hospitalized no less than 50 people are aware. This includes the doctors, nurses, phlebotomists, radiology techs, transporters, cleaning staff etc. To think a hospitalization is a private experience is a expectation based purely in fantasy. Using EMR’s will at least create a way for hospitals to monitor who is viewing records and make sure those records are only being viewed when necessary. This is how UCLA has been able to track down the staff members involved in the recent breeches of celebrity patients. Another point I made in this post was that medical information has little to no street value, this is compared to social security numbers and bank account information. Well, here is the evidence for that position. A patient admissions rep at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York sold 2,000 patient records for a whopping $1350. That’s less than 68 cents per record. Again, these security issues are important but considering a large percentage of us just recently e-filed are taxes and are awaiting our refunds to be direct deposited, which required providing our government a social security number and bank account number, these security issues should not continue to be used to prevent the progress in web based health care technology that will lead to more efficient and improved patient outcomes.

Welcome to the SavvyDoc Blog

This was simply an introduction to what we are looking to accomplish with SavvyDoc. Through my experiences I have seen how difficult it can be for patients to obtain access to a quality physician or dentist. We are also aware that it is expensive and difficult for doctors to create a strong presence on the Internet. SavvyDoc is looking to be a simple and inexpensive alternative for both doctors and patients. This recent NY Times article on plastic surgeons and examining the expense of marketing cosmetic practices illustrates a lot of the pain we are alleviating with SavvyDoc. This article touches on the expense of obtaining and maintaining a website that is search engine optimized as well as the expense of being listed in a doctor search engine. Many doctors cannot justify these expenses but understand that they should have virtual access to their patients. SavvyDoc will provide an easy to use tool that puts doctor’s in control of how they are marketed and how patients find their doctor’s information on the web.

Further thoughts on reducing health care costs

In my previous post on health care costs, I argued for further adoption of technology to help alleviate the long term cost issues that are plaguing Medicare. I briefly mentioned the impact the transparent appointment system we are creating at SavvyDoc will help to alleviate the over-crowding in emergency rooms. I was prompted to spend today relating the trickle down effect of web based doctors appointments on the ER because of this Wall Street Journal Health blog post describing recent research showing that the uninsured are NOT to blame for ER overcrowding. This is a common misconception that I am glad the WSJ picked up on. The uninsured unfortunately avoid health care all together. The cost of an ER visit is significantly more expensive than an office visit, so to think that uninsured patients are going to the ER for a bad cold is a false premise. The question then becomes why are insured patients visiting ER’s with such frequency? Thanks to the work being done at the Institute for Health Care Improvement a lot of the reasons for this phenomenon have been illucidated.

Before I go further, the primary source for the statistics in this post come from this JAMA article by Dr. Mark Murray (the link is to the abstract, you will need to visit your local library or have a JAMA account for access to the full paper).

In his paper Dr. Murray argues that issues with health care access are actually due to delays in obtaining care. For instance, in 2001 it was found that 40% of ER visits are not urgent and could in fact be seen in a primary care office setting. I have not seen recent research on this, but as the population ages I would imagine this percentage is increasing. Imagine for a moment the improved wait times in an ER if half of these patients were able to easily obtain a last minute office appointment rather than going to the ER. Realizing that the median ER visit is four to five times more costly than an office visit, think of the economic implications of patients easily finding an open office appointment rather than going to the ER. There are billions of dollars to be saved just by fixing this one problem in our health care system!

The follow-up question: why do patients see it as easier to sit in an ER for hours rather than going to a doctor’s office? Well, at least patients know they can be seen in a somewhat timely fashion in the ER. In 2001 1 in 3 patients reported an inability to find a timely appointment this increased from approximately 1 in 4 patients in 1997. Again, this number is likely rising as our population ages. It does not take a stretch of the imagination to realize patients who cannot find a timely office appointment are deciding to go to the ER for care.

Solution. A transparent wed based appointment system would allow patients to look for any last-minute appointment openings. Patients who desire last-minute care would prefer to see the doctor they are familiar with. Searching for that doctor on SavvyDoc, will allow patients to see if there is availability within the next 24 hours. If that doctor does not happen to be available then further searching will allow patients to find a doctor within their area that is available. The alternative is to walk into a crowded ER waiting room where the patient has no information on who their doctor will be. Our market research to this point has shown that patients overwhelmingly see the value of making on-line appointments with their doctor. Patients are becoming more savvy about how to use the internet for researching information on doctors as well as information on their health. Providing the opportunity for patients to have more control over the appointment making process has wide ranging benefits, this impact on reducing unnecessary ER spending is one of the most significant.

What does a Chicago sandwich shop have in common with SavvyDoc?

For those of you in downtown Chicago or have spent time there, there are many Potbelly Sandwich Works located every couple of blocks. For those of you not familiar with this restaurant, it’s a combination of Subway meets Starbucks. For many people, it’s a daily routine for their lunch hour. You can get a toasted sandwich and a pretty good vibe, all for about $5. Amateur musicians play in the background, and the cafe/restaurant is always filled with upbeat, high energy people.

While offering such a unique environment for a reasonable price, they have to have quite a bit of volume to stay in business. Sales per square foot are the name of the game, and Potbelly wins just about every day. Lines can be seen being formed outside of the restaurant, seemingly a huge bottleneck. Potbelly’s has done quite a bit to ensure that the throughput of the restaurant is reasonable, so that everyone keeps coming back during that vital lunch hour, which can make or break a downtown fast-food restaurant in Chicago.

Lately, I have noticed that they have really been promoting their website, where you can place orders, and pick up your food without the wait. Your sandwich will be prepared, so you can eat and run, or take your food back to your office. In promoting this website, they have inserted postcards with orders and have made it highly visible through every step of the order process when you’re in the store, that there is a viable alternative, not aimed at replacing the current way most people grab lunch. They are aiming to target those individuals that value convenience and speed, over long lines. From a business perspective, they improve their throughput and can better anticipate demand through a transparent system.

With SavvyDoc, we aim to do the exact same thing. We don’t aim to replace using the telephone to make doctors appointments, we want to make it easier for those individuals that highly value efficiency and transparency. For us to be successful as a company, we do not need to have 98% of the doctor’s patients utilizing the online tool, it’s a system that can alleviate the bottlenecks so the physician can better anticipate demand. As an industry, by most studies, far less than 10% of the carryout orders are done online, yet it translates into a multi-billion dollar space. For tech savvy individuals, ordering online is a huge plus, which GrubHub capitalizes on.

Their are inherent bottlenecks in making appointments, which is why in our market research, 20-30% of the office staff’s time is spent on patient scheduling. Imagine the impact if 40% of the the appointments were done online. Imagine this power, coupled with decreasing the no-show rate, filling last minute cancellations, and the ability to recruit additional patients to the practice. That’s the goal of SavvyDoc. Some patients will enjoy utilizing SavvyDoc because of the real-time scheduling, but there are still others that may not see the value, but as with online banking, over time, I believe that it will be just as common, at least we at SavvyDoc think so.

SavvyDoc Myths Part 2

One of the biggest myths when speaking to people about our product is the lack of attention to the marketing value proposition that, in my opinion, is one of the strongest aspects of our service offering. In our market research, we’ve found that 37% of the dentists claimed to have a website, yet 18% of their patients actually knew about it. With the SavvyDoc platform, we give the physicians an easy to set-up website, that enables them to provide much more information than most physician websites, in an easy to read and edit format. Most of the physician websites that we’ve come across look like an off-the-shelf solution, that is extremely arduous for the physician or their staff to update or easily manage. If they need to make a change, they have to hire a webmaster or IT specialist that can be costly.

With the SavvyDoc profile page, the physician can easily edit their educational information, awards and certifications, languages spoken, insurances accepted, payment methods accepted, and a host of other fields that take a couple of quick clicks of the mouse. The physician won’t need expensive software, or have to worry about maintaining their server and website, because that’s SavvyDoc’s job. We provide the back-end support and systems upgrade, which allow the physician to do what they went to school for, practicing medicine and helping people.

With our market research, we found that there are actually two main demographics for doctors in this space; those 28-39 and the over 40 physician. In that market research, we have also found that the 28-39 demographic cares about acquiring more patients to the practice, and the over 40 physician would like to maintain a solid pipeline of new patients, but their primary concern is to streamline and enhance their practice.

For the 28-39 individual, the marketing aspects of SavvyDoc is a tremendous value add. With our embeddable schedule “widget” which enables anyone to add the physician’s schedule to their blog, personal website, MySpace account, and soon to be completed LinkedIN and Facebook accounts, we aim to provide endless access points to the schedule of the physician, which is both viral and useful, the key to all widgets. Additionally, we spent a considerable amount of time enhancing the search engine optimization of each physician website, to ensure that they are located at the top of Google searches, not some spam site which provides inaccurate data about physicians. With over 117 million U.S. adults searching for health information online, you, the physician, want to be where the people are searching, and SavvyDoc will be the most cost effective solution. We provide analytics that detail just how many people are going to your SavvyDoc profile so you can test different marketing campaigns and promotions to determine what works best from a marketing perspective.

Additionally, we are going to provide additional services and marketing tools for the doctors to market themselves, and we’ll touch on them later on, so stay tuned.

SavvyDoc in the Chicago Tribune

A couple of weeks ago, we were fortunate enough to be included in a Chicago Tribune article discussing some of the presenters at the Midwest Venture Summit, a showcase of the hottest start-ups in the Midwest. In the article, we were featured along with PatientImpact, LLC, a company that aims to improve the patient experience. It really was an honor to be included as one of the top start-ups in the Midwest, considering that 95% of the presenters had been in business for several years, even some with funding.

One major take away from the Chicago Tribune article is that there is quite a bit of improvement that is needed in the health space and there continues to be a disconnect between doctors and patients. Innovative tools such as SavvyDoc and Patient Impact are necessary to bring about change in this space, a space that has been slow to adopt many of the same basic tools that many other industries utilize. With quite a bit of money flowing into this space, we will see quite a bit of innovation, but it has to start from the basic foundation of providing tangible tools that benefit both the patient and the physician. There are tons of software providers out there that aim to provide software for private practices. In speaking with the people that use this software, whether it be the physician or their office manager, the learning curve to adequately use the software is too high, because the software is too bloated with too many features and minimal automation.

With SavvyDoc as we built the software, we aimed to make it as seamless as possible, and as easy as possible. We don’t want to wow anyone with a million features, because too many features equals too complicated. For any user that utilizes the power of SavvyDoc, we want you to always be 3 clicks away from meeting with your physician. We also want any physician to register with the SavvyDoc platform in less than five minutes, and we have purposely patterned our back-end administrative tool to be as easy to set up as a facebook profile. Web 2.0 and the social networking phenomenon of LinkedIN and Facebook has enabled us to expand our boundaries of what social software can do. With SavvyDoc, we’ve mashed together Software-as-a-Service and social software, to make a streamlined tool that makes it easy for patients and physicians to get the job done easily and quickly.

The Doctor’s dilemma: How to maintain a profitable practice?

Last week I commented on the role IT has in reducing healthcare costs and in particular how adopting web based appointments can provide doctors with an immediate ROI whereas other IT tools are viewed as long term investments. In doing more research on the financial stress placed on doctors as Medicare reimbursement decreases, I came across an essay by Dr. Sandeep Jauhar that I believe is particularly good at framing the issue of high healthcare costs from the doctor’s perspective. Dr. Jauhar, a cardiologist from Long Island, argues that patients undergo unnecessary tests and procedures because of a combination of pressure from patients wanting everything done for them and the need to counteract low Medicare reimbursement with increased volume. A pointed example is given where a cardiologist describes needing to perform 10 non-stress tests a month to break even. As a physician that was a difficult example to read because despite the reality of this doctor needing to run a profitable practice I cannot help but consider the implication that there are patients undergoing tests at the end of a month not because it’s medically indicated but because the doctor needs to break even for the month. My comments are not here to condemn doctors, we are doing the best we can to treat as many patients as possible within the confines of a complicated system that forces the healthcare provider into moral dilemmas. It does not take a rocket scientist (or neurosurgeon) to realize the easiest why for a doctor to maintain a profitable practice in the face of decreased reimbursement is to see more patients in clinic, order more tests and perform more surgeries.

To maintain profitability there is a heavy focus by doctors on maintaining their revenue and there has been little attention to decreasing the costs of running a medical or dental practice. The seeds for a transition to making health care more efficient are being planted by such organizations as the Institute for Health Care Improvement , a non-profit where one of their stated goals is to improve efficiency in health care. They provide doctors with tools to learn more about the inefficiencies in their practice. There are many suggestions for improving office workflow. One recommendation in particular is to match the supply and demand in an office practice. We believe web based scheduling is an IT tool that can be used to help private practices match supply and demand. When a practice uses web based appointments a doctor’s patient population can quickly and easily make appointments or change appointments in a way that matches supply with demand. If a doctor finds that on Friday afternoons he or she has low demand but on Wednesday morning demand exceeds supply, that doctor can place open appointment slots for Friday afternoons and encourage their patients to seek open appointment times. This type of system has the added benefit of preventing patient dissatisfaction on Wednesday mornings that inevitably occurs from long wait times. Implementing IT tools like SavvyDoc allows the doctor to maintain profitability, increase patient satisfaction and avoid the moral hazard described by Dr. Jauhar.

Health blogs. Good or bad idea?

Geoff Simon for Webpronews wrote an interesting post about whether health blogs are a good idea. In his post, he highlights how historically, the medical and legal industry rarely, if ever, advertised their services. There was a negative stigma attached to doing that, and in many ways, it still exists today. Oftentimes, when you see a commercial of a law firm on television, you are inundated with personal injury attorneys or the ambulance chasers of the industry. In many ways, this stigma is very apparent in the medical industry as well. When was the last time you saw a television commercial for your local dental practice?

I don’t believe that my private practice physician even advertises. With the advent of health blogs, there are tremendous opportunities for a physician or health care practitioners to establish themselves as a value added resource to the Internet community. In many ways, a doctor blogging can be equivalent to that physician paying for a radio ad, with the negative stigma attached to it. The physician’s peers have traditionally frowned upon this sort of practice, and this will change very soon.

With over 117 million U.S. adults searching for health information online, wouldn’t it be great to have physicians educate the public on various illnesses and treatments, rather than some social network flavor of the month located at the top of the search engines? The beauty of the Internet is the ability to find relevant, up to date information, and WebMD has been a benefactor of an increasing trend.

The downside to this is we have no idea how accurate, nor the full disclosure to determine whether the information we search for is presented from an objective point of view. There still are major hurdles that we need to overcome, which makes us all better off. There needs to be blogging networks, that enable physicians to educate the public, but an oversight community to ensure that the information that is disseminated is accurate, and with full disclosure of conflicts of interest. This is indeed easier said than done, and a great deal of the change has to start with the physicians tapping into the marketing power of the Internet, with tools such as SavvyDoc.

As a tech enthusiast who has followed some of the great technology blogs such as Mashable, Techrunch, and ReadWriteWeb, the conversations and exchange of information has really augmented the pace at which innovation occurs. I believe that it can also occur in the health space with minimal oversight where their only objective is to maintain accuracy and full disclosure. If this can happen, SavvyDoc benefits, but more importantly, we all benefit from the content that can be produced and syndicated. Web 2.0 has been all about the exchange of information and the two-way conversation. By incorporating more of Web 2.0 within the health space, we may be take innovation and discovery to the next level.

Thoughts on reducing healthcare costs

On Tuesday the Bush administration released a report on the financial situations of two very important federal programs, Social Security and Medicare. The financial outlook for Medicare is particularly grim where funds for the program will be exhausted by 2019. Today’s article in the New York Times does a good job of reviewing the political implications. Healthcare has gotten a lot of play during the current political cycle and has led to particularly heated debates in the democratic primary. Without getting overly involved in political commentary, I will simply state that any policy needs to focus first on significantly lowering the costs of healthcare in this country before attempting to insure everyone. The system is built to withstand a modest number of uninsured patients but the current crisis is derived from the number of uninsured increasing rapidly due to out of control medical expenses.

In my experience the two mostly commonly quoted causes for the high cost of healthcare are medical malpractice and the cost of pharmaceuticals. These issues have been discussed at length. They have a significant impact on healthcare and need to be addressed. However, I see more significant factors ‘in the field’ and actually believe they are easy to address and would require jumping significantly fewer political hurdles. Obviously, since this is blog on the intersection of healthcare and technology I see this synergy as paramount to decreasing healthcare costs. It has been well documented the positive effects of technology through electronic medical records, electronic physician orders and electronic personal patient records. Each decreases medical mistakes and improves communication between healthcare professionals. The impact of decreasing medical mistakes on healthcare costs is intuitive, but improved communication has an even greater impact. Better communication leads to fewer mistakes, but also makes the system more efficient. As an example the patient with a medical emergency that has full and detailed records that are easily accessible will have their treatment expedited as time won’t be wasted gathering information from multiple unconnected sources. The impediment to progress in healthcare IT is not political, everyone agrees it is important and will eventual lower costs, in fact the president even briefly mentioned healthcare IT in his State of the Union address.

The issue slowing widespread adoption of technology in medicine is the initial cost and who is going to pay for it. The Medicare issue is at the crux of this problem, the government cannot afford to implement IT as it would cripple a program that is already on its last leg. Thus, the onus has fallen on the medical profession and particularly doctors. Problems arise as most doctors see patients in a small private practice. Expecting a small business such as a private practice to implement electronic medical records, or sophisticated IT tools that allow easy communication between an office, hospital and pharmacy is initially unrealistic if there is not an immediate return on investment (ROI) for the doctor. This is where IT tools such as SavvyDoc become the catalyst for integrating technology and healthcare as the doctor obtains an immediate ROI when creating a transparent appointment system. That ROI is realized by decreased patient no-shows as patients make appointments that fit their schedule or easily change an appointment as the patients situation dictates. Also, when doctors market open appointments those appointments are exponentially more likely to be filled. There are other farther reaching positive impacts of transparent appointments on the overflow situations we currently encounter in our emergency rooms but I will save that for a follow-up post. The major point is that as we watch these debates and develop our conclusions about the candidates and how they will or will not improve our healthcare system we cannot ignore the importance of healthcare IT. As a physician I have little to no influence as an individual on lowering costs by fighting the malpractice insurers or the pharmaceutical companies, but I can easily make the decision to embrace and implement technology.

Fears over Patient Privacy

Today it was reported by the Washington Post that a government laptop computer that held medical information on 2,500 patients enrolled in a National Institutes of Health study was stolen in February. According to the article the breach potentially exposed “seven years worth of clinical trial data, including names, medical diagnoses and details of the patients’ heart scans.” There was no breach of social security numbers, phone numbers or addresses. As the information was mainly scientific in nature it is believed there is low probability that this data can be used for identity theft. My issue with this situation was how it was handled by the NIH. Rather than informing patients of the stolen laptop immediately the decision was made by NIH officials to stay quiet as to not provoke “undue alarm“. The decision to not inform the public speaks to the over sensitivity to patient data security, I doubt if many of 2,500 patients are overly concerned about their medical information being breached. This is not to say that the information should not be protected, if NIH officials are going to carry patient information on a laptop or any portable device that information needs to be encrypted (this laptop apparently was not). The NIH and any healthcare organization should confess to security issues immediately, the idea that there will be mass alarm over such an incident is not an excuse to withhold information. Plus, this is health information not an imminent national security threat. I have touched on this before , but this incident shows why the healthcare industry is so slow to adopt technology it’s the industries lack of understanding of how to use technology more so than the technology itself. As more patient information is placed on electronic medical records issues of security will undoubtedly occur and with more frequency and likely with greater consequences to individuals, however these growing pains will be necessary in order to create a more efficient and effective healthcare system. Those in control of healthcare information need to trust that the public will react appropriately when there are security issues. Not doing so will only make the public more leery and stifle an already slow process.