Lack Of Data Standard, Not Meaningful Use To Blame For Crap EHR Systems

Meaninful Use and EHRs

Let’s not blame the carrot (Meaningful use) for the stick (Electronic Health Record systems) being too short!

If we want to make Electronic Health Record systems (and Practice Management systems) better, cheaper and actually innovate, then we need a standard schema for how core data is stored so that it can be easily exported to a different EHR at the drop of a hat.

Despite the availability of $35 billion of federal funding to incentivize the adoption of this new health information technology, results have been disappointing.  For one thing, physicians, nurses, and other health professionals who rely on such systems on a daily basis reported steadily decreasing levels of satisfaction with them.  The move to electronic records has not only failed to enhance patient care but in many cases actually interfered with it.

Meaningful use isn’t the reason that EHR systems are so fundamentally crappy and exorbitantly expensive, it’s that once you sign a contract vendors know you’re going to be with them for 5 – 10 years because an automatic lock-in is created by the prohibitive costs related to implementation, staff training and patient data transfer.

Sure, there are standards for interoperability, but as far as I can tell there are no standards defining how these companies actually store the patient data within their systems. Or, if we feel this is too much of an imposition, standards defining a schema for importing and exporting of information from the system (what they do with it in their system is their own business).

There are criteria for a data export for a certified EHR but of course they fall short of providing a real solution:

We also note that this functionality is not intended to and may not be sufficient to accomplish a full migration from one product to another without additional intervention because of the scope of this criterion. Specifically, the data and document templates specified in this criterion would not likely support a full migration, which could include administrative data such as billing information. The criterion’s functionality could, however, support the migration of clinical data between health IT systems and can play a role in expediting such an activity if so determined by the user.

This leads to very expensive and time-consuming conversion processes, which usually results in only a partial import of the data your practice needs being imported.

I recently handled a migration from a well established server-based product to one of the largest cloud based providers. Much to my frustration even a basic list of referring providers couldn’t be exported from one and imported to the other without connecting directly to the SQL database, exporting the data, then reformatting to match the new vendors schema, manually creating some data columns that couldn’t be reliably split programmatically and uploading to the new vendor.

The patient demographics were a considerably larger nightmare.

We could have paid the vendor to do it but that would have taken longer than doing it myself and would have cost considerably more.

A defined standard for core data portability would make it incredibly easy to demo solutions from vendors as you could import data into a test environment, evaluate the system with real patient data instead of the often useless test data many vendors load into their demos, and enable practices to make better informed decisions about which solution to invest in.

Needless to say data portability would increase competition between vendors essentially forcing them to focus on what practices actually need, delivering better user interfaces, improved user experiences and lower costs – all of which adds up to products that are easier to use, cost less and create more time for physicians and their staff to actually focus on patients.

Stop Over-Analyzing and Build Your Referral Network

Build Your Referral Network

Note: The alternative title for this post was “Getting Bogged Down In Data”.

If there’s one trap that everyone falls into at some point in their marketing career, it’s over-analyzing. We all know how important it is to track the right data when you’re launching a new campaign, or building out a referral network for your medical practice or small business – but over-thinking which data-points you need can actually lead to precrastination and a lot of wasted opportunities and delays.

To be fair these issues tend to be befall those relatively new to marketing more than anyone else, but even experienced marketers can fall into the same trap when faced with something they’ve never had to work with before.

These delays and wasted opportunities are not what our clients are paying us for. Our clients expect us to hit the ground running and create actual results, but how do we do it?

Let’s assume you’ve never built a referral network for a medical practice or small business before and you’re suddenly thrown in a the deep end and have to start building one at an established practice that previously handled all their own stuff. You’ve been handed a couple of spreadsheets that they’ve been using to track referrals, but they appear to have somewhat contradictory data. Where do you begin?

Talk to the client and set your goals:

Confer with your client and find out what is they wish to achieve. Obviously they all want to add to the bottom line, but for most medical practices it will be something like: “Renew relationships with past referrers who aren’t sending as much work, strengthen relations with existing referrals, and bring in new referral sources”.

Examine the existing data:

Use past data to figure out who you need to be courting to bring them back into the fold. Most practices and small businesses will have some form of referral tracking in place, and the very least they should be able to pull data from their CRM or practice management solution. If the don’t then you’ll have to do some extra leg-work with the client.

Discuss your observations with your client as some declines in referral sources may have “political” reasons and may be a waste of your energy. Very often your client will have a fairly good idea as to why someone stopped referring to them and this can give you very valuable insight into how to approach them.

Do your research and identify new referral sources:

Chances are that the sources referring to your client are not the only fish in the pond. Get online, hit up directories and find out what other potential referral sources are within your client’s catchment area.

Decide What Information You Need To Track to be effective:

The previous three steps were easy, now comes the part the holds most people up – deciding what information to track and how to track it. The more information you track the harder it can be to find a tool that will allow you easily manage the data, and frankly, the more work there is for you. After a certain point the tracking of unnecessary information becomes a burden and a time drain. Too much data can cloud your view. Lets keep it simple.

Get yourself a whiteboard.

Write down all of the data points you would like to be able to track (Name, contact info, NPI number, past referral numbers etc..)

Go have a cup of coffee and talk to someone about something completely different.

Come back to your whiteboard and start erasing all the data points that you don’t ACTUALLY need! Be aggressive. If it’s just a “that would be nice to track” but doesn’t actually help you beyond looking pretty on a spreadsheet, then kick it to the curb.

If at the end of your murderous erasing spree you’re tracking more than 6-8 data points you’re doing it wrong.

Track Your Information And Visits – Get A CRM

Finding a CRM (Customer Relationship Management) solution that fits your needs is considerably easier now they you’re only tracking a handful of data points, but there are somethings that you will want to consider.

  • It should allow you to easily import contacts from your email platform
  • It should integrate with your email platform so that you can tag emails and assign them to relationships and organizations
  • It needs to have strong note taking abilities
  • It should have a strong mobile app. You don’t want to be carrying a laptop around all day or filling in your notes when you get back to the office. If you can do it all on your phone, then YAY!
  • It should be scalable – someday you may grow your consulting activities beyond yourself

Also, keep in mind that you don’t need to enter all of your potential referrers information in straight away. Add them as you intend to visit them, and any competent CRM will start building relationships and tracking organizations as you tag emails and correspondence leading to organic population.

As an added bonus, a CRM will help you track your progress, projects and tasks, making reporting to your client considerably easier.

Prioritize your list

Based on your research and existing referral data you should now be able to easily prioritize the practices that you need to reach out to first. Talk to your client once your list is complete – explain your reasoning as they may have some insights into the meetings you’re about to setup.

Start making phone calls, sending emails and hit the streets.

Get out there. There’s nothing holding you back now except you and your willingness to make contacts. Send your emails, make your calls, visit offices, attend conferences and events, shake some hands! Track and analyze your results, rinse and repeat accordingly.

Medical Practices Simply Can’t Afford To Skimp On IT Infrastructure

1964, Dynamic control problem being studied in the Analogue Computer Laboratory
Analogue Computer Laboratory – 1964. Source.

The Earth orbits the Sun, and medical practices can’t afford to skimp on IT infrastructure… some facts are simply immutable.

Normally I would proclaim that any business can’t afford to skimp on its IT infrastructure, but given the current climate where just having a Windows XP machine connected to your network is a HIPAA violation, I’ve clearly got a certain target audience in mind for this post. That said, it’s not just medical practices that could benefit from taking a few minutes to read this post.

I’ve spent a lot of time the past months advising (and implementing) practices on how to make the move from the no longer supported Windows XP to Windows 7 and newer operating systems, and one thing has become readily apparent to me – there are two kinds of medical practices:

  • Practices that see technology as part of the patient experience.
  • Practices that only think about IT when it breaks.

The medical practices (and other businesses) that realize that their IT infrastructure is part of the patient (customer) experience tend to have made the realization that IT in a medical office is not just there to scan ID cards, print receipts or create patient forms, but actually adds substantially to the patient experience and bottom line of the practice.

Happy patients = more money!

That’s not a difficult concept right? I think everyone can agree that if a patient has a positive experience at your office they’re more likely to come back the next time something ails them. They’re also far more likely to recommend you to other potential patients (word of mouth marketing), leave positive reviews on rating sites, etc… Happy patients = more money for you. Simple!

A lot of medical practitioners and office managers appear to forget that the patient’s experience in their clinic is not just measured by the patient – doctor interaction, it comes from the everything they experience at your office. From the moment they walk in the door, from that first impression, the friendliness of the staff, the promptness of their appointment, the ease of filling out information – it’s all being judged by the patient and it ALL impacts your bottom line.

So, how does IT actually affect any of this? Well, let’s forget about silly little things such as multi-thousand dollar fines (per patient) when data is exposed due to poor infrastructure and / or running out of date operating systems and look at the ways that keeping your computers and software up-to-date actually affects your bottom line.

Faster computers (and modern operating systems) increase staff productivity.

It’s not just just the ability to run better, newer software, but multiply the 10 minutes it takes those ancient computers to start up by the number of staff you have and there’s a massive amount of wasted productivity hours. A lot of time is wasted every day because applications take forever to open / switch between, and all of that wasted time is time that you are paying staff for. If  you want to get more productivity from  your staff then give them the tools to do it.

Faster computers equal happier staff.

In my experience, there’s little that will annoy good staff in a good office faster than slow computers. It’s frustrating to have to not be able to move on to the next thing, especially when you have a patient standing there waiting for that document you sent to the printer 5 minutes ago.

If there’s one thing patients are especially good at picking up on, it’s the atmosphere in an office. When staff aren’t happy, you can be sure that patients aren’t, and that is going to have negative impact on their experience and willingness to return in the future or recommend  you to other potential patients.

Faster computers equal happier patients.

When you’re sick, tired or in pain, the last thing you want to do is stand around twiddling your thumbs for five minutes at the check in desk at your doctors office waiting for their EMR (electronic medical record) system to pull up your details. That should have happened almost instantaneously, and it would have if the aging computer had more RAM, a faster CPU or better connectivity to the server.

Get those patients checked in and out faster for a better patient experience and a less crowded waiting room.

Keeping your infrastructure up-to-date saves you money.

All computers break down, have issues and occasionally need repairs, but performing support tasks on older computers takes longer. Slower machines take longer to install drivers on, track down issues etc. It’s not rocket science.

As your infrastructure ages there tends to be more issues which require support and the cost of that support can escalate rather quickly. You might only see it as a $100 here, $200 there, but when this is happening every other week (even when you have contracted support agreements) it can quickly get to the point where you could have actually paid to replace aging equipment and had LESS support call-outs.

Upgrading / Staying up-to-date doesn’t have to be a huge expense.

A lot of small practices get sticker shock at the notion of spending many thousands (sometimes tens of thousands) of dollars to replace equipment that still essentially works. Most don’t realize that these upgrades don’t all have to be done at once. Unfortunately a lot of vendors won’t tell you that, instead going for the big “all in one” sell – but that’s another blog post.

Implement a rolling upgrade policy. Start with the oldest computer (or computers depending on how desperate the situation) on your network and get them upgraded – whether than means adding more RAM, SSD’s or a better CPU or simply replacing the whole machine. If you have a server, see if that needs upgrading too. In 6 months time upgrade another machine or two and continue to do so over the next two years. By the end of the two years you’ll have completed 5 upgrades (0 months, 6 months, 12, 18, 24) and have replaced or upgraded 10 machines without any one major expense.

Most small medical practices will have somewhere in the region of 10 – 20 machines, but you can adjust the plan to suit your infrastructure needs and budget accordingly.

On month 30, start the cycle again – upgrading the components of or replacing the machines first updated at month 0. Repeat the cycle over and over again and you’ll never have machines more than 2 – 3 years old running on your network.

You may also wish to annually evaluate your networking equipment and see if any performance gains can be made by upgrading aging switches / firewalls / routers to newer faster standards.

Remember that it’s not just your hardware.

Aging software can be a productivity drain almost as much as aging hardware. Be sure to evaluate new versions of the tools and software you use in your practice and determine if making the move to newer versions could increase productivity or will add features that improve security etc..

Speaking of security… Don’t forget those updates…

Again I’m going to gloss over the potential fines that medical practices and businesses can be slapped with if patient / customer information is compromised, and instead remind you of the cost of having someone come out to clean your network of trojans, spyware and malware. Good anti-virus and anti-spyware software is always a must, but none of it is perfect. No matter your operating system – Windows, OS X, Linux… make sure that you are installing updates regularly. These updates don’t just add new features to your system- they fix bugs, can increase stability and performance, and fix security holes and issues.

If your IT person (you do have an IT person, right?) recommends that you turn off Windows updates for performance, or because things “might break” then you need to fire them. The days of such things happening are long, long in the past, and the rare times that they do occur are far lest costly than the potential damage than can be caused by not running them.

While you’re at it, have your IT person or vendor upgrade the firmware on you routers / managed switches / firewalls etc….

It doesn’t cost a lot to be secure AND productive…

For most practices, if you put your IT infrastructure on a rolling upgrade cycle the cost becomes pretty negligible plus you get to avoid the major sticker shock of a one time upgrade.

If you start thinking about your IT as part of the patient (and staff) experience the outlay will more than recoup itself in increased productivity, repeat patients and positive word of mouth marketing.