Navigating in the rough waters Part 1: (small practices)

Navigating in the rough waters Part 1: (small practices)

During these difficult times, I find it that the media is more focused on the negative news and the problems that businesses are facing, rather than making recommendations and special reports on how we can become part of the solution. In our group, when we have our weekly brainstorming sessions, we discuss our economy and go around the room asking all individuala to provide feedback in the following format: what can we do to help practices navigate through these rough Waters and be part of the solution not the problem.

This was the mindset that we have been in, even during consulting with clients. As healthcare technologists, when we meet with clients and discuss how we can assist them with their technology needs, we focus on listening to what they are looking to resolve. And more than ever, where are hearing that it is about how we can use technology to “SAVE THEM MONEY, and INCREASE THEIR REVENUE” as well as how is the new administration is going to assist them.

So, in my mind it is two subjects that we need to tackle.

PART 1: Plug the leaks in your practice

When I got married, my wife and I were young and eager to see what it feels like to live on our own house. We chose to rent an older home close to my work for about a year. During that period, we were paying off school loans and such, and trying to save as much money as we could. Things went well during the summer up until the winter time. Living in the Carolinas with 30 degree temperatures had raised our gas bill to over 300 dollars a month. Keeping in mind that we both worked full time and had a relatively small house (1200 sqft), we did not know what to do, and the landlord did not care much. We knew that it was too expensive for us, so we had to do something about it. The only option we had while bound to a lease contract was to find ways to save on our gas bill. So we came up with a good short and effective list of solutions:

Wear thicker clothes and lower the thermostat by an additional 3 degrees.

Request the landlord to put weather stripping in all the cracks and the doors to the outside.

Close the rooms that we don’t go in and close the vents in them.

Perform maintenance on the Heating unit to get it to function efficiently.

While we knew that this was the last time we would live in a home without doing an initial inspection, we were extremely pleased with the results that we saw the next billing cycle. We were able to save over 40% on our gas bill. This was a great solution that had measurable results.

With the similar model, I found that we can apply different solutions to a medical practice that can help cut costs, and especially during this difficult economy. The following are some examples of things that can benefit a practice through the use of technology:

Review the clearinghouse services you are getting and add more functionality

Things to consider:

Patient eligibility: Get your money upfront when a patient does not have valid insurance, and eliminate the need to waste resources in filling an already denied claim, in that this will be saving precious staff time and money.

Automatic Electronic Remits Posting: if you thought about it in the past , and were too afraid to try it, well this is the best time to make the jump. Eliminate the time spent on data entry for the payments by allowing the system to do it automatically for you. This will give your billing staff enough time to allow them to focus on getting the AR where it needs to be.

Claim Submission: There are still practices out there that send claims via paper. This is the time for the switch. You are wasting your dollars if you are paying someone to print, folder and mail a claim. You can save on stamps and staff pays to do it electronically.

Practice trends: Getting the right reports to help you realign your practices goals is critical. Since you are still a business, it is important to see how you are doing and not wait for a phone call from the accountant at the end of the year. Some clearinghouses offer dashboard that give you a snapshot of where you stand, and what are certain services that are more financially beneficial to you than others

Working your collections and statements

Things to consider:

Outsource Statements: It is nice to see how we can have an assembly line when working on statements. One person prints, the other folds and stamps, however having a company that will reduce your costs and errors is far more beneficial in the long ran. You can start to see saving right away with this method, by uploading your electronic statements and letting them print them and mail them for you.

Outsource Collections: While it is nice to get a third party collection agency to call and try to get your money back, it is critical to choose the right company. One that will not make you loses your patients by scaring them off. These services will help you get more of your money, and allow your staff to be more efficient.

Revisit your IT support and maintenance contracts

Things to consider:

SLA contract and flat fee support package: This is the one thing that motivates an IT company to do the best job they can, by preventing problems. Having an SLA (Service Level Agreement) forces the IT Company to try to minimize the time spent on a problem as they want to ensure that they would need to spend less time on fixing things they can prevent to keep the margins up.

Get a good lite Preventative maintenance package “lite managed Services”: While it is a common practice for an IT shop to recommend monitoring the workstations, the servers, and even the temperature in the room, you only need to have monitoring done on critical equipment in your building. The front desk computers, or the ones in the break room are not important devices, you can save yourself money by buying some spare ones and keeping them in the back ready. Your main goal here is to prevent major downtime and loss of revenue by focusing on monitoring Backups, servers, server room temperature, and logs of critical applications such as RIS/HIS/EMR/PMS/Exchange... The provider’s tablets can be skipped as long as there is a good policy and training around saving important files or personal documents to the local computer disck drive, which would jeopardize data.

Get that EMR you have always wanted today

Things to consider:

Gethe best package for the best price: Because of the tough times and some good old competition, we finally have affordable EMR/PMS packages, and plenty of room for negotiations. We are seeing 20 to 30% off some of the top EHR packages out there. This would be a huge savings that might not last for long.

How About Free EMR: If you haven’t heard this yet, well it is true. You can get a free EMR and the only cost is the maintenance and support. OpenVista is the OpenSource (developed by a comunity of developers) EMR product developed and currently used by the V.A. in many hospitals. There is a commercial version of the product that medical offices can use and its Free!

Get Free Money from the government

Things to consider:

Grant money: whether you are a Community Health center or a private practice, the new administration is working on some great packages to offer as part of the healthcare modernization push and Stimulus package. Our president Obama is looking to get Healthcare IT some much needed financial assistance to get us where we should be. So, you have to start looking at the details of the stimulus package and how you can get approved for that assistance.

Free or low cost e-RX: Take advantage of the bonus that Medicare is currently offering. If you are seeing a large volume of patients from Medicare, then you should highly consider implement e-prescribing (e-Rx). This 2% bonus based on your anual reimbursments will last up until 2011 and then it will be reduced to 1% bonus, and by 2013 you will start losing about 0.5% of your total reimbursements from Medicare.

Remove the paper based tasks

Things to consider:

Low end scanning solution: Get with your IT Company or Copier machine guy and see what you can do about those paper EOBs that you have to keep in the back. While most of us think that we can shred them, it is critical to keep them around if you ever get I.R.S. knocking on your door, or one of the payers decides to take back some money and you need to have some supporting documentation for a claim or two. Turing your EOB into electronic documents will save your staff a lot of time as they will not have to spend a lot of time looking in boxes and such for 10 minutes or more for a single EOB.

Hybrid document management system: This is by far the most cost effective EMR and paperless solution. It offers the best of both worlds. Having all the benefits of an EMR while still keeping it simple to use for the clinical staff, and still maintain the same amount of patients and workflow.

eFax: Implement an eFax solution. You only have to spend just few hundred dollars and get a complete eFax solution. Believe it or not, you can get a complete eFax application for free as part of your windows Server 2003. All you need is a modem. This will save your nurses from having to chase paper lab results, and other faxed patient documents. One other advantage is to eliminate the need to spend time scanning, filing them, or the toner when printing them.

Consider refurbished workstations

Things to consider:

Refurbished workstations: As the computer prices have dropped, there is potential saving in buying refurbished workstations. They still hold the same warrantees, and would still run just as good as the new ones.

Free software

Things to consider:

Free office tools: Many practices thing of Microsoft Office suite when you mention word processor. In reality, you spend over 299 on to get those applications. I highly recommend looking at the free OpenOffice.Org OpenSource product. It does everything that word, excel and PowerPoint do. Except it will cost you 0 dollar.

Lower your electric bill

Things to consider:

Turn off the switch: Turn off PC, speakers, calculators and monitors automatically. Many of us underestimate the power consumed by PCs even when we don’t use it. During the night time when a PC is in standby, it is still running up your bill. So, if you want to save 30% or more on your energy consumption then buy a smart power surge for your workstations. A power surge like “Power-Saving Essential Surge Arrest 7 Outlet with TEL 120V” for as little as 20 dollars. This surge protector is smart enough to sense when the computer goes to stand by, and then it shuts off power to the PC, Speakers, calculators, digital picture frame, and last but not least monitor. This is truly a great out of the box idea that will save you tremendously on your electric bill.

EMR ASP vs. Client/Server

Recently, I was asked by one of our clients what were some of the advantages and disadvantages of going with an EMR that is running on ASP (application service provider) model or an EMR on a Client Server setup.

Unfortunately, few online articles have labeled the ASP model as the EMR where you don't own the data, and also the Client Server model where you will suffer from terrible performance if you have multiple locations.
So, I wanted to provide some alternatives to the models listed above. When you look at the ASP model, you will find that it can be divided into two very different modes that have very different advantages and disadvantages.

Please view the following Comparative analysis: Click here

Disaster Recovery and Business Continuity Plan

There was a time in my youth I was told to be proactive in order to maintain my cars to get the most out of them. I believe that was one piece of advise my father gave which I should have listened to. Especially after going through two cars with blown engines during my college years. Today, in technology i have seen similar situations that do not get the proper attention, and assumptions are being made until the day you are faced with a true disaster then realize that you are all alone and no one to blame but yourself. The moral of this little part of my life is: "You should always monitor and perform checks on items that are important enough in your work or life".


In today's Healthcare information technology, many components go unchecked, and when disaster strikes, several organitations suffer from many directions.



So, now looking at all the complex systems that are implemented in today's health care, from a small medical office, to a large IDN the reliance on technology one must wonder, how can we better prepare for any disasters.

Working with small to mid size practices one of the key mistakes that I have seen repeatedly is the lack of awareness of what their backup consists of. There is actually a small list of things they must know but no one tells them about:


Current challenges:

• No one knows where the IT service support stops and when the PMS vendors begin.


• Are all the practices important documents stored on the server with all the other major data, or is it still lingering under the "My Documents" on the office managers desktop.


• Is the data restorable?


• Is the data being backup daily (are the backup logs monitored.) PS: "in some applications, if one file is missing the data may be unusable."


• If the practice is not using Microsoft Exchange or Lotus Notes, are their POP3 emails being backed up?

Solutions:

• Design or request a network and application layout.


• Request documentation or weekly reports on backup logs


• Implement restore drills even on a testing server. (You can actually lease servers to perform tests on.)


• Discuss disaster recovery with your staff, providers, IT support, and all your software vendors. Remember each software can have specifics when it comes to recovering from a technical disaster.


• Identify what applications are business critical and which ones are not.


• Make sure the backup rotation is appropriate. (Weekly is not acceptable, and can cause you financial and legal penalties).


• Discuss your disaster recovery process with your insurance (it can lower your premiums if you have implemented and documented best practices.)


• Invest in the right solutions up front. In many cases it might seem that you should settle for the low cost backup solution with limited storage without accounting for the growth of your storage over the next few years. Think of where your EMR plan might come in the picture, and when you might decide to scan all your paper chart. Your backup storage should be an investment that will have to be done wisely. You should not have to replace your backup solution in a year or so. So, ask if the backup you have in place is upgradable, and scalable.


• Implement server monitoring to allow for your servers to be reviewed for errors that can help in preventing disasters.

Disaster recovery for Hospitals and large organizations...to be continued..Once we move to a hospital /IDN environment, it is a different challenge. It becomes clear that it is not just a question of putting in the storage infrastructure alone, but more of having to manage the following:

• What will be covered (if there are other organizations that might not be in the same geographic area)
• Awareness and preparedness (understanding the risks to the business as well as the challenges that will need to be overcome.)
• Procedures that would need to be implemented in order to guarantee that everyone is on the same page. From an IT prospective all the way to the Disaster Management Team and staff.
• Technology infrastructure. This would include plans to either have a hot site ready with data that is replicated real time, all the way to stand by servers and solid backup or virtual platforms.

From a technology standpoint, there are many challenges that the IS department is faced with is the vast infrastructure that is in place. To point out few of them that we see in Figure 1.1.

Figure 1.1

There few more items tat might be missing from the Figure 1.1, such as the integration engine that keep all the hospital system all integrated and patient information centralized. Ranging from SUN JAVA CAPS all the way to MS BizTalk servers. In addition, there is the task to coordinate with all the different vendors. Any thing from the RAD system to the EMR servers that might be under maintenance contracts through a third party.

Reda Chouffani.. To be continued.....

who's the best candidate for the HIT job for your health organization?

Here we are in the new year 2008 with new resolutions and updated goals for all our healthcare organizations. This year we might be looking at making changes to our technology infrastructure. We also might be looking at adding new providers to the practice or even extending our hours to compete with minute clinics. Whatever we have decided to accomplish, somewhere in that list you will find something related to the healthcare technology.

In recent years many organizations are finding out that they are spending a lot on technology.
So we ask ourselves are we better off hiring our own HIT (Healthcare IT) to support all this complicated environment?
Is it worth to have someone 8:00 to 5:00 in the practice to solve our technical challenges? Some even are saying that they can afford to have an IT person on staff for the amount they spent last year on an outside IT vendor?

Many of the above questions are valid. As we look at some of the medical groups that either use an IT firm or have an internal person we notice that each has its advantages and disadvantages.


In house IT person:

Pros:

• Immediate support (no delays or phone calls needed)
• Costs are always fixed and in budget
• The person know how the practice works and the workflow
• Single point of contact for all technical needs
• Extra set of hands to use for other items if the IT queue is low
• Coordinate and manage projects that involve multiple vendors
• lower cost

Cons:

• Limited knowledge (one person can not be an expert in all IT technologies)
• Some IT personnel are very talented in technology but not knowledgeable in the healthcare domain
• Having one person responsible for all IT can be too risky.
• You get what you pay for (Being technical might not mean good project management or being on board with organizational goals)
• Noway of knowing if the work is done properly and the best practices have been used

Outsourced IT person/Group:

Pros:

• With an outside company you actually hire a whole group of talents (server support, workstations, PMS, Interfacing, Medical Imaging, Integration,..etc..)
• Having access to a group with extensive experience in the healthcare market
• Accountability tend to be greater here as it is a company not an individual
• Not one single point of support (Having a group know your infrastructure means that if one Tech is not available, then there are many others that can take over and get you up and running.)
• Provide integration ideas and solutions to improve efficiency and lower costs
• provide best processes and procedures (procedures on disaster recovery, backups, security, HIPAA, asset management, monitoring system health..)

Cons:

• Can we say $$$$$
• Response time is slower than inhouse IT staff
• you sometimes get support from someone who is not familiar with your infrastructure which drives costs up.
• Sometimes vendors are selling more than what is needed

In today's Healthcare, not one method is better than the other. Just like everything in life, it is a balance that creates the best results. The best pattern to use here if you are a large practice would be to have an inhouse IT person that can handle the day to day issues, but also hire an outside healthcare IT vendor to become your virtual CIO. This way, the HIT can be the top layer that can keep an eye on your infrastructure through continuous audits, and meetings and also provide solutions and direction when it comes to projects that will affect the practice. Some might argue "well what if I don't have enough IT work to be done for this person?" Then the other option would be to negotiate with HIT vendor to get a Hosted IT person. You can pay a set amount of dollars and they can provide you for a term of 6 months or more an IT person that can report to your practice everyday just like one of your employees. This means will also allow you to have access to the "Virtual CIO" for your practice and have an IT person that you can decide to terminate when you choose to.

Now if you are a small practice and none of the above options are valid, then you will find that the best way is to look for a local IT vendor that supports other medical offices and has a good reputation. They should be able to provide you with good support and for a fair price. But still consider paying for an outside consulting to come in once a quarter and tell you what are some of the technologies that are out there that can help you become more efficient and improve patient care.

With all these new initiatives and constant changes in Healthcare technology. From e-Perscription to RFID technology, EMR, and PHR how can anyone know for sure what would truly have the highest ROI for their practice. Most IT vendors can provide the same type of support for equipment, but the key is to have a company that can act as a virtual CIO for your group. A vendor that can work with the Office manager or the Practice Director and help them implement the right technology that goes along with their organizational goals.

Another Great year full of solutions and happy clients

Well, as the year 2007 comes to an end, we look back and reflect on what we have accomplished so far and there is a lot to be thankful and proud of. In the Healthcare IT you think that all the solutions have been implemented and they are all out there for you to use, but looking at what our team has come up with and accomplished tells a different story. It is clear that solutions are completed unique in so many ways. You can take an integration done by a group XYZ and compare it to another one by ABC and you will shocked on how different they are even if they have the same purpose. Being involved in technology is one of the best things that ever happened to me. You get to design and implement different ideas that resolve different challenges everyday for clients. because every one's need is different there is an endless amount of opportunity to create something that will make a different for the other.

One other interesting point is that you don't necessarily have to have years and years of experience to establish best solutions. Much of the talent we have in our group is young out of our local area (little town called Mooresville or race city USA), but by having a little faith and knowledge of the domain they are able to brain storm some impressive things. It goes to show that you don't have to be a multi million dollar company to have the best solutions or products out there, its about having the right combination of people, skill and leadership.

This year we have gone and bid against larger software vendors to provide IT support as well as software solutions, and we came up ahead and won most of those bids. That I think is something that I am very pround of. Because sometimes you sit back and wonder, I am competing with someone that has millions invested in marketing, staff, branding and so forth, but we just present the products and show how they can apply and make a different to the clients, and with our reputation, the clients dont seem to find the need to question all that, and once they use our solutions and see the type of support we provide and one and one relationship we have, they are very thankful for the decision they have made.