The Office 365 products and services go well beyond the simple creation of presentations, web pages and spreadsheets via web tools.  They contain a valuable set of features and functionalities that end users are dependent on for day-to-day work.  And as we look at health care and its own line of applications that enable better, more connected patient care, one must wonder if there will be a time where electronic health records (EHRs) will learn from the lessons that companies such as Microsoft and SalesForce have identified as critical for success in the software industry.

The following is a list of eight takeaways from cloud-based applications that EHR vendors should consider as part of their long term software development strategy:

Make it cloud or browser-based: Given the pace at which technology change is moving today, IT is more focused on aligning organizational objectives and ensuring compliance rather than managing physical servers and the downtime associated with them.  For that reason alone, many organizations are now looking to leverage cloud-based or browser-based products that require low up-front costs and offer higher up time, availability and redundancy.  Vendors such as Cerner, AthenaHealth and others provide a full hosted application model where there is very little need for a full infrastructure in-house to maintain the application.  In addition, with this model, a cloud-based application requires very little maintenance and experiences very little downtime that could be associated with upgrades, conversions or system updates.

Low up-front cost: In every EHR implementation, there are several items that contribute to the high costs.  From workflow redesign, training and hardware procurement, to software licensing, maintenance and product support, many see the future in solutions that are provided at a monthly fee per user or business unit.  This reduces the up-front costs and allows for the organizations to appropriately budget and justify the use of the new products and solutions.

Scalability: For products that are offered through SalesForce, Google, or Microsoft office 365, it takes the same effort to sign up 5 users as it does to sign up 5000 users; the system is designed to easily scale out.  This is all done behind the scenes, where the client is ready to start using the application right away.  This capability would benefit EHR vendors greatly as their products continuously need to have the ability to scale out, especially when there are clear indicators of health systems mergers, acquisitions and growth.

Easy to use UI: One of the critical success factors for any user-facing product in the market, including EHR packages, is an easy to use, functional and feature rich user interface (UI).  Many EHR systems fail to impress clinicians simply due to the busy and cumbersome UI.  These products must be  easy to use and allow health professionals to attend to their patients without feeling lost in the software.

Integration: As we move toward a health care model that rewards for outcome measures, complete patient care and care team collaboration, many applications are starting to look for ways to allow for protected health information (PHI) to be exchanged, safely and securely.  For Google docs and Office 365, having the ability to connect to other systems, as well as the collaboration platforms, was a useful function in the products.  This would also be a significant feature for EHR packages.  While some do provide the ability to receive and submit health information across a given HIE, there is still a significant lack of adoption from physicians.

Collaboration: Microsoft and Google chose their own collaboration platform as part of their products.  Within Office 365 and Google Docs, there are capabilities for end users to use video conferencing and chatting capabilities.  This provides a useful method for users to communicate beyond the simple email messages.  As accountable care organizations (ACOs) begin to implement their collaboration platforms, there will be a clear demand for chat, audio and video conferencing capability.

Platform agnostic: For software vendors in today’s market, the big question from the majority of prospects and potential buyers is: “Do you have an app for that?”.  That said, for many of these products, having the mobility capability as part of their offerings is now a must-have for clinicians.  Whether it is a hospital system or a small independent physician practice with two physicians, a medical application should have some sort of mobile application that will allow its user access to the information from smartphones, tablets and many other mobile devices.

Power is in the numbers: There are clearly some very powerful players in the EHR marketplace.  These are the groups of vendors that are well established and have had incredible success with high number of users.  However, this does not always mean that there would not be a place for a disruptor.  And in the world of technology, especially the world of software products, it is all about the new, functional differentiators that a product brings to the table and the perceived the value that the software has from users in the market.  Similar to SaleForce, AthenaHealth, Facebook, Chatter, LinkedIn and the other very successful sites, there will continue to be room for new innovators that can disrupt the marketplace and continue to push the technology buck forward, especially in health care.

But as we continue to see EHR flyers and marketing brochures outline the benefits of not using paper charts, we can pause and recognize that there are factors other than the typical benefit that will eventually drive physicians to seriously consider adopting EHR. There are several reasons that can put a medical organization who still relies on paper chart at risk. Especially when we are seeing the transformation that is currently happening the US healthcare system.

Following is a list of 6 items that can put the paper based practice at risk in the near future if they don’t adopt an EHR?

More patients will be asking for it: As more patients get exposed to the benefits of their physicians using EHR and see how a healthcare providers who uses EHR can communicate as well as share medical information with them electronically (such as: X-Rays Lab results, treatment plans, e-prescriptions, and PHR), many of these health service consumers will begin to ask and look for physicians who are using these technologies. This would provide many organizations with a competitive edge and enable them to differentiate themselves from others. This could potentially penalize physicians who are not using electronic health records by losing new patients to their competitor.

Telemedicine and servicing a broader geographic area: Several large health systems are beginning to provide basic health services and specialists consults over video conferencing and for a reduce rate. Many of these services are provided via secure communication channel and do not require for the organization to have a physical office near the patient they are servicing. But many of these physicians that will provide telehealth services will be in need for an EHR to be able to share information quickly. This provides them with a competitive advantage as they can efficiently service a broader patient base outside of their immediate community.

Everyone will be collaborating but you: Some states have already implemented an HIE and as more adopt the health information exchange and some of the care delivery models, many physicians are starting to exchange and collaborate on care. These physicians are able to receive complete patient summary of record electronically and share their information about a patient with others as well. This is also the vehicle that will used by physicians to communicate and collaborate on care as well. But for physicians who are still paper based, they may encounter more challenges when attempting to collaborate and be a member of the care team for certain patient population.

Using remote health monitoring to manage chronic conditions: With the increase in patients with Chronic disease and the current competitive market, many health organizations are looking to adopt technologies to assist with remote patient monitoring services. These would be ways to capture health information and monitor patient’s vitals real time. These technologies would require physicians to have some sort of EHR in place to be able to transmit the information to.

Recruiting new physicians: As part of the medical school curriculum, many new graduating physicians have had exposure to electronic medical records. This would most likely suggest that many of them would favor practices and health organizations utilizing EHR for their future employment opportunities. This would make it difficult for paper-based practices to recruit talent.

Penalties, employers and payers will demand it: Some of the current incentives through MU may not fully cover the costs associated with software and hardware for a new EHR, however some predict that penalties and lower reimbursements may cause more heartburn for physicians who elect to stay with paper charts.These pressures will continue to mount, as there is an increasing push for modernizing the US healthcare.

For many products in the EHR market today, there are actually only subtle differences in terms of their capabilities and functionality. But at times, these are the exact features that can be the key to a successful implementation of the EHR, or not. One could almost apply the Pareto principle here, or the 80-20 rule, where approximately 20% of the features possess the key differentiators and and critical success functions, while the remaining 80% comprise the common features found in most EHR systems.

Some areas of consideration that have spurred conversations among decision makers regarding EHR package evaluation are:

• How effective would some of the products be when interacting with HIEs?
• How are the different EHR solutions going to take ACO models?
• What are some of the different mobile capabilities would be available?

As we’ve been privy to watching unfold, technology has been playing an increasingly important role in the effective, efficient delivery of health care, and continues to present opportunities for innovation and offer a measurable value to both physicians and patients. From utilizing an HIE for better coordinated care to adopting mobile technology and integrating mHealth devices for the viewing of radiology images, lab results or e-prescribing, we are going to continue to see adoption of tools that will not only prove to drive down costs, but also improve the overall quality of care.

For organizations that have selected an electronic method to capture patient information and clinical data, there are several options from which to choose:

Web-based forms: These forms are browsers based (such as html forms) and offer the flexibility of being available and accessible without the need to pre-install anything. They also can be viewed using almost all current platforms and provide the ability to store all data captured from the users as discrete. However, the organization would still rely on web developers to make changes to these forms.

Thick forms: These are the forms that run within specific applications. They are similar to the forms that are available in most EHR packages that are used to capture clinical data as well as registration data. Unfortunately, these forms often are fixed and not easily changeable. They are also only available in the package of which they are a part. We can classify some of the forms available through mobile devices, such as the iPad and Android tablets, under this category as well. MHealth tablets have already seen several apps in their repositories that enable end users and/or patients to enter the data directly into the devices. These forms are, in most cases, written specifically for that platform (iOS or Android).

PDF forms: PDF forms have been one of the most commonly used forms in the industry. These forms can be generated from MS Word documents, or simply by using many of the available off the shelve form builders. They also offer the flexibility to store the data in XML and/or directly to a database. They provide the ability to perform front-end data validation and can run on almost any platform.

Digital Pen: These not so ordinary ballpoint pens can capture handwriting and drawings from special digital paper forms. The information is captured in the device and then uploaded to a central server, where it is then processed and automatically converted into text. While this concept simplifies the capture of data, unfortunately there is still the dependency on the accuracy of the handwriting recognition software and quality of the symbols, which may cause some concerns if the information is not readable.

OCR-based forms: Optical Character Recognition, or OCO, has been around for a while and utilized in many markets, from banking, to the justice system having the ability to scan through a document and recognize the handwriting. An organization can use any form, which provide tremendous flexibility, but unfortunately you are still dealing with a paper document that requires scanning and then disposal as part of the workflow.

The reality is that we are simply finding hospitals using a combination of the above solutions to resolve their data capture challenges. The market had some promising technologies out there, and at one point, xforms showed some promising results, but lacked wide adoption. I was very disappointed to see that xforms did not gain popularity, as it made a lot of sense from a conceptual design standpoint. Similar to XML (XML is a widely adopted method to exchange data across systems in a standardize format), xforms relied on a standard “xml” like method to describe the fields, data types. That meant that many applications had the ability to easily display the forms included mobile devices, as part of an application or simply viewed via browser.

But luckily the dream of having standardized coding for form building has been reborn again through HTML5. Not only can HMTL5 be viewed from any browser or device, but it also means that the forms can easily be modified using web based tools and some of the advanced web authoring applications.

I am most definitely not asserting that HTML5 is the only way to go. There have been many more successful technologies available that enabled efficient data capture across applications and platforms. But we simply need to have some standardization and interoperability in these forms.

Healthcare will always require some data input from patients, family members, clinicians and other staff members. Different devices will be made available for this purpose from tablets, kiosks, mobile devices and desktops. And to ensure ease of use and improved workflow, the technology has to be there to support the overall mission, and so far it’s still too early to tell which technologies will be best suited for the age of electronic data exchange.

Original Article

I don’t have to tell you that the burden of administrative and clinical documents in a medical practice is considerable. Busy offices lead to inaccessible administrative documents and charts; whether misplaced, lost, or in use by another staff member. Physician practices continue to seek solutions to reduce or eliminate the increasing volumes of paper within their organizations.   The problem is that most people do not know where to even start. To make things worse, so many have heard horror stories about offices adopting Electronic Medical Records (EHR) solutions that cost a fortune while making the providers life miserable. Furthermore, most EHR vendors want you to upgrade your PMS as well. Why should you? If it isn’t broke don’t fix it.

Most physicians need solutions that streamline their business processes instead of re-engineering their clinical practices. Paper is an excellent place to start, because paper remains the cross enterprise medium of choice for all of healthcare. Even the most advanced medical operations are still awash with EOBs, consent forms, and legacy charts. Electronic medical records manage clinical work flow, but they do not eliminate paper. So let’s find a way to transform your paper documents into digital data! An EHR scanning solution is an option that unfortunately is usually expensive and cumbersome. It requires too many clicks and trained personnel who are adept at using the EMR.

The truth is that you must be made aware of another solution that may be more attractive to you in terms of cost and functionality.

A document management solution is a cost-effective way to meet your paperless office needs at a fraction of the cost. Document management solutions typically allow you to print a barcode on your everyday forms so that after they are completed they can be scanned and automatically filed in an electronic chart. Typically, the chart is a folder that resides in an electronic representation of a filing cabinet.  The barcode identifies the patient and the document type. Once the chart is scanned, it is automatically saved and can easily be retrieved and viewed on a PC, or on a laptop. There are many advantages of having an electronic document such as:

• The chart can be retrieved quickly and reliably – this concept eliminates the problem of lost charts
• Eliminates the cost of paper charts
• Frees-up the space that was utilized to store physical charts
• The system is more user friendly then a typical EMR since you are still working with forms you are familiar with
• Because you are working with your current forms, you don’t have to change your office workflow; instead you can configure it for “best practices”
• Electronic data can now be backed-up safely offsite
• Multiple staff members can access the same chart at the same time
• Charts can be accessed from anywhere – on the road, in your home, or at the  hospital

Examples of document management packages are:

1. Omnipage Professional – Less than $500.00/Per License.
2. Cabinet NG - Cabinet NG is somewhat more advanced and can be purchased for about $1,350.00/Per License.
3. eDoc Health - If you want a more healthcare centric product see eDoc Health. This is an advanced solution that supports order taking, ePrescription, imaging, patient registration,  reports and etc. This solution can be purchased for less than $1,2500.0/Per License.

Step 2- Throw Away Your Prescription Pad

E-Prescribing gives you the ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care. E-Prescription is proving to be an important element in improving the quality of patient care and enhancing patient safety. E-Prescription is a program that can run from your PC, Laptop or even a smart phone.

• Medication Lists – See what medications your patient has been prescribed, even by physicians not affiliated with your practice.
• Integrated Drug Reference – Access the fully integrated drug reference system to access complete information on all medications with a few clicks.
• Allergy and Drug-Drug Interaction Checks – Check the prescription against your patient’s known allergies and against any potential drug-drug interactions.
• Faster Data Entry – Eliminate unnecessary data entry by pre-populating your prescription with patient information to ensure you send a complete prescription every time.
• Quick Access to Frequently Prescribed Medications – Utilize fast, one-click access to frequently prescribed medications and common dosages.
• Better Formulary Compliance – Know which drugs are covered at what level by their formularies. Integration with Surescripts, a health information exchange group, enables e-Prescription to compare medication with the patient’s insurance coverage.
• Send Scripts Many Ways – Submit electronically through the SureScripts network to more than 85% of U.S. pharmacies. Prescriptions are automatically faxed or printed to ensure the fastest most convenient delivery of the prescription to the patient’s selected pharmacy.
• Pharmacy History – Record the patient’s preferred pharmacy, making writing subsequent prescriptions that much easier.
• Convenience and Flexibility – E-Prescription uses either a web browser or your mobile device leaving no need to phone or fax in prescriptions. You can process refills in a matter of seconds.
• Improved Legibility  – Use menu driven selections and electronic transmission to eliminate legibility issues. E-Prescription helps with JCAHO compliance because it does not use unaccepted abbreviations.

Subscription to services such as Rcopia can be purchased for less than $70.00/Month Per Provider. Click here for more available E-Prescription services

Step 3- Eliminate Your Fax Machine

The Electronic Fax comes in two flavors, either a hosted fax solution that you buy as a service or as software that is installed on one of your office computers and connects to the internet. Today, either solution can be HIPAA compliant as they support encrypted data transmission.

An electronic fax system allows you to fax reports, prescription requests and patient records from any software that is installed on an internet connected computer. Any document you can send to the printer you can send as a fax. You basically click on the fax option just like you click on the print option.

• No Need to Print – Eliminates the need to print-out documents that will eventually be faxed to colleagues or clinical facilities. Time delays that are frequently encountered when an office fax machine is busy are eliminated.
• No Special Training Required – Once incorporated into a software application, provides seamless, intuitive faxing of clinical documents.
• Privacy And Encrypted Security – Protects clinical documents by using SSL/PKI encryption.  HIPAA concerns are fully covered by electronic faxing’s enhanced privacy features.
• No More Trips to the Fax Machine – Your faxes can come directly to your machine in the form of an email.

Examples of electronic fax service are:

1. eFax – This solution can be purchased for about $26.00/Month.
2. myFax - This solution can be purchased for about $20.00/Month (Rates Based on Fax Volume).

Examples of electronic fax servers are:

1. FaxBack - This solution can be purchased for about $2,000.00.
2. Snappy Fax – This solution can be purchased for less than $500.00.

When installing a fax server on your network fax volume does not affect the cost of the solution.

Conclusion

Elimination of paper by scanning charts, using electronic prescription and electronic fax is a cost effective way to:

• Minimize manual processes that slow down your workflow
• Minimize human errors
• Reduce frustration for your staff
• Free up your staffs time so they can focus on your patients
• Reduce cost of operations
• Enhance patient care