Choosing a microphone is one of the most important decisions you can make when implementing a speech recognition software like Dragon Naturally Speaking Medical 10. Thanks to Eric over at Speech Recognition I’ve gotten some interesting information about a microphone called the PowerMic II. Looks like it’s a microphone on steroids. Definitely one other microphone to consider when selecting a microphone to use with voice recognition software. Here’s an overview of the PowerMic II utilized with Dragon Medical 10 thanks to 1450, Inc. with commentary by Jay Goodfellow.

OVERVIEW:
The PowerMic II is a speech recognition microphone designed to be used with Dragon Medical 10.

However, the PowerMic II is much more than a hand held microphone. It is a powerful tool that enhances a physician’s control of dictation and navigation through documents, templates, electronic medical records and other applications. It has been designed specifically to be utilized with Dragon Medical 10, and the extraordinarily tight integration shows that to be true.

Not only does the PowerMic II have full mouse functionality, but there are 10 function keys that are programmable to provide practically any operation that a physician might want to do on his/her computer.

Yes, you can already use Dragon Medial 10 to do almost anything you want to on your computer by voice. However, using the PowerMic II and Dragon Medical, you substantially enhance your ability to do essentially anything you’d like on your computer, using the more convenient method at that moment: voice or function button.

The PowerMic II is designed to be fully functional with Dragon Medical 10 only. Dragon Preferred 10, Professional 10, and Legal 10 are not capable of using all of the programmable PowerMic II features.

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Today I came across an organization called the Electronic Health Record Association (EHRA). It looks like it’s kind of a consortium of EHR vendors that are also members of HIMSS. I’ve just begun reading some of the work and goals they have. A very interesting organization. I have much to say about what I’ve read, but one of their main initiatives seems to be the EHRVA Interoperability Roadmap. I took a quick look at version 2 of the document to try and gain an idea of how they were trying to accomplish the lofty and difficult goal of interoperable EHR/EMR software.

Briefly looking at the document one section in particular caught my eye that was called “Prerequisites for Achieving Interoperability.” I was excited to read what they thought was important for interoperable EMR software and the following is what I found:

The path to interoperability is fraught with challenges. Some of them are technical – determining what standards should be used to achieve interoperability and implementing those standards within HIT systems. Some are cultural – encouraging both vendors and providers to share information. And some are financial – identifying sources of funding needed to acquire the technology and to establish and sustain health information exchanges.

Nonetheless, we believe that interoperability is achievable, under certain conditions outlined in this Roadmap.

I was really disappointed in their list of prerequisites. Not one mention of the legal issues related to interoperability? That seems like one of the largest problems with interoperable medical records. It kind of falls under cultural, but it still should have at least been mentioned under cultural if that was their intention. An interoperable EMR is no use if legally you can’t exchange those records easily.

At least they did talk about the need to find a motivation mechanism for vendors and providers to share information. The honest truth is that interoperable EMR software doesn’t sell more software. Not to mention, there’s very little financial benefit for a doctor to spend time sharing information either.

The key is that interoperability is important and finding ways to meet/overcome these prerequisites is important and worthy of significant attention.

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One night this week I decided to take a look at some of the various research, conferences, etc that were being done by HIMSS. While visiting their site I came across an HIMSS virtual conference. You can imagine my intrigue since I’ve wanted to attend the HIMSS annual conference for a while and just haven’t been able to manage the scheduling or expense for the conference. That’s the great part of the HIMSS virtual conference: it’s free and I can watch it from the comfort of my office.

Don’t get me wrong, there are definitely some drawbacks to an online conference. There is something nice about seeing someone face to face and experiencing a live demo of a product. Not to mention the free conference giveaways and free dinners with vendors. However, there are also some great advantages to a completely virtual conference also. Take for example, the networking with colleagues. I think almost all of us are familiar with the feeling that we should be networking with those around us. Yet, there’s kind of this uncomfortable feeling of how to start a conversation with those around you. One nice thing about the internet is that it helps to take down those barriers and allows people to feel more comfortable interacting. It’s worked really well for guys meeting girls online and so I don’t see why a virtual conference couldn’t offer the same benefits to its attendees.

I applaud HIMSS for this move into the virtual conference world. I’m excited to see how it plays out this Wednesday, November 19th and Thursday, November 20th. There are a number of HIT sessions that look interesting along with some EHR, e-prescribing and even an opening keynote about healthcare and politics. You can see the full list of sessions here. I’d like to see a broader range of sessions and a larger “vendor floor” (albeit virtual), but for a first offering I think that HIMSS has done a great job.

I have a meeting here and there throughout the virtual conference that I have to attend, but I’m sure I’ll be active in the conference chat rooms when I am attending. Also, I’ll be posting updates to my Twitter account if you want to follow me there. You can also follow HIMSS on twitter now too.

Here’s a link to register for the HIMSS virtual conference. If you’re planning on attending also, let me know. I’d love to see what other bloggers plan on attending.

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I’m sad that I didn’t see this list until now. Mike Gleason provides an interesting list of reasons why small practices aren’t implementing an EHR as fast as we’d like them to implement. Here’s his list of 10 reasons:

Fear
Ego
Money
War Stories
No one wants to go first
Product not perfected yet
Waiting on Govt mandates
Waiting on hospital install or Stark gift
I have people for that
Change

A really great list. Mike also discusses each of these points. As time permits I’d love to take some of his points and write some comments on each.

More important for this post, I wondered what other reasons might be missing from this list. Here’s a few others that I came up with:

I’m retiring soon
I don’t like computers (similar to “Computers Scare Me”)
Procastination/Lazy
Commitment problems (can’t decide on which EHR system)

Those last couple sound a lot like why many people don’t get married. Pretty interesting since I’ve compared implementing an EMR to marriage multiple times. Any other reasons for not implementing an EMR that we’ve missed?

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Today, I decided to start a new web page that I believe will really grow over time. It’s basically a list of the possible benefits a doctor or clinic can receive from using an EMR or EHR rather than paper charts.

I haven’t take much time to make the list at all, but I think it’s better to start it and then as ideas come to my head I can add to it as time permits. I already have a number of other ideas (like quality of medical care), but I need some more free time to put all the details down. Now that I’m thinking about it a little bit more, maybe each benefit of an EMR should have it’s very own blog post describing the benefit that’s received by using EMR. We’ll see how that works. Seems like a worthwhile series of posts to me.

Also, in all fairness I’m certain that I’ll also soon be creating a list of problems associated with EMR. I think it’s important to keep the discussion well rounded and that people are well aware of both the benefits and challenges associated with using an EMR.

Finally, I certainly welcome comments from people on benefits or challenges associated with use of an EMR. I look forward to hearing ideas from other people’s experience to help me round out the list of benefits and challenges that many have already experienced first hand. Might as well try to pass on that knowledge to those who are still implementing or looking to implement.

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I posted the 2008 CCHIT List of Ambulatory EHRs and asked if any EMR Companies were interested in commenting on the CCHIT process. Joe Rubinsztain of gMed was willing to do a guest post on gMed’s experience getting the 2007 CCHIT Certification and the motivation for an EMR to become CCHIT certified. Joe provides some interesting insight into an EMR company’s perspective on CCHIT.

CCHIT certification is the government’s way to ensure a common EMR denominator. In principle, this is a good idea to help confused physicians choose interoperable products with common features. In practice, however, CCHIT testing is young and requires fine-tuning to ensure that all requirements are practical and relevant.

About gMed
gMed was founded in 1997 to create a better alternative to the paper medical chart. Weston, Fla.-based gMed’s Digital Charting system integrates medical information, cuts costs, increases revenues, improves quality and reduces risks for selected medical specialties, including gastroenterology, cardiology and urology. More information is available at http://www.gmed.com.

Thanks Joe for the guest post. I always welcome guest posts from EMR and EHR CEO’s. Nice to get an EMR company executive’s perspective on an interesting topic.

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Since I’m so interested in the EMR and EHR space, I’m always interested when the new list of companies is published of who has passed the CCHIT Ambulatory EHR certification. Not because I think the certification really means much. I’m more interested to see which EMR companies are spending the money to become and maintain certification.

Take a look at the list:
Community Computer Service Inc.
MEDENT 18

eClinicalWorks
eClinicalWorks 8.0

Epic Systems Corporation
EpicCare Ambulatory EMR Spring 2008

Greenway Medical Technologies, Inc.
PrimeSuite 2008

McKesson Provider Technologies
Practice Partner 9.3

MedLink International, Inc
MedLink TotalOffice 3.1

MedPlexus, Inc.
MedPlexus EHR 9.2.0.0

NextGen Healthcare Information Systems, Inc.
NextGen EMR 5.5.27

Pulse Systems
Pulse Patient Relationship Management 4.1

VIP Medicine LLC
SmartClinic 16

Interesting that only 10 companies are on the list considering the over 400 EMR companies I have listed. Plus, I’m sure my list is not complete by any means. That’s another project I’m working on that I hope to announce in the not so distant future.

Doesn’t certifying only 2.5% of the EMR companies out there pretty much make that certification useless. I hope people aren’t being wowed by the certification. I’m also not saying that all of the EHR companies on the list are bad “jabba the hut” EHR companies either. My point is to remind people that CCHIT certification doesn’t test usability of a system. So, EHR buyer be ware!!

I also love how most of the EHR companies listed have a child health component. I wonder if most of those on the list just did the certification this year so they could get the child health EHR certification. Hard to rely deny the marketing value of saying CCHIT compliant.

I’d love to hear from any of these EHR vendors that are CCHIT 2008 Ambulatory EHR certified. I’d be happy to dedicate a guest post from those interested in listing their reasons for paying all that money for this EHR certification.

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Well, I’d been meaning to link to my friend Ducknet or as she calls her blog, The Medical Quack, for a while, but never got around to it. I figured it was about time since she’s been posting like crazy on that blog and deserved a little love.

I must admit that she posts a ton of medical related content. In fact, probably too much for me. I’m a little bit of a healthcare snob and have my preference for EMR and/or IT in healthcare. Ducknet has an incredible tech background with experience working at Intel and TabletKiosk. I’ve often turned to her on Skype to ask her details about the latest processors or the best tablet pc for my doctors to use with our EMR. She’s always been spot on.

Plus, she finds nice little nuggets of EMR industry knowledge that I hadn’t seen until now: Misys Purchases Allscripts. That’s a really interesting industry consolidation of what I would consider a very weak brand with a very strong brand. Kind of reminds me of when HP and Compaq came together (can’t remember who bought who in that one). The interesting question is which EMR software system will emerge from the Misys purchase of Allscripts.

Hopefully the Allscripts marketing team is kept in tact. I liked their use of social media to promote EMR.

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My main hobby is playing with social media, website marketing and things people like to call viral marketing. So, you can imagine my interest in this EMR video from Allscripts describing the benefits of EMR ina really unique way.

I love what Allscripts is doing. They even have a channel on YouTube called AllscriptsTV. I’m not sure this is the right way to market an EMR, but I’m impressed with what they’re trying to do. Things like this will hopefully start to break down barriers to EMR adoption.

I will admit that a couple things disappointed me about the video. It was much too long. The same message could have been told in about 2-3 minutes instead of 5 minutes. Even the most entertaining videos are best at 2-3 minutes. With a subject as raw and uninteresting as EMR, 2-3 is plenty long.

I was also quite disappointed with the link at the end. The image seems to state that there will be a discussion of EMR at the website listed. However, instead of a discussion of the various EMR issues, it was just basically an advertisement for Allscripts with a few simple comments. Maybe I should have assumed that it was commercially driven, but I had hoped for more of a conversation if you’re going to claim it’s a conversation.

All in all, the video makes some amazing points for those looking at EMR. If I had the time I’d go through the video and list the points they make. They were just that salient.

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In the past I’ve covered a number of different free emr software programs. However, honestly I don’t think I’ve touched the surface of the various free and open source EMR software that are out there on the market.

Today I came across a really interesting article talking about the first release of a free open source emr coming out of the Philippines called FFEHR.

“This is groundbreaking for several reasons: it is free, portable, and open source that even doctors can contribute to its development,” Dr. Alvin Marcelo, manager of the International Open Source Network (IOSN) Asean+3 node based in Manila, in an interview.

I wonder how many other similar EMR and EHR projects are going on in countries around the world? I’d love to hear about them if you are working on one. Also, there’s a small chance that I may begin a job working with mostly people from the Asia Pacific area and so I’ll be very interested in seeing how these open source EMR and EHR projects will affect the developing and developed nations in that area.

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I received an email not too long ago from a medical billing company who talks about the crazy costs associated with medical billing. In their email they offered the following statistics on the costs of medical billing.

The statistics below represent industry averages taken from the MGMA.

Claims Rejected on 1st Submission - 30 %
Underpayed Claims - 20%
Gross Collection Rate - < 60%
Preventable Denials - 90%
Denials that are Recoverable - 67%
Average days in A/R - 52.32
Cost per claim - $5-$7
Cost per FTE physician - $30,000-$60,000
Cost of billing operations - 18-22%
Cost of Billing Personnel - 58-62%
Cost of Technology/ Practice Management Solution - 18-22%

Source: Avisena whitepaper

I must admit that billing is far from my expertise, but it’s a well described necessary evil for almost any practice. Plus, the better you do it, the more money your clinical practice can make.

Of course, my question is how did implementing an EMR in your clinic either help or hurt these various costs? Were you better able to process claims, because the charting was done electronically and the coding done at the time of visit? Were you able to process claims at a higher rate because your documentation was more complete using an EMR? Could you more quickly process denied claims because it was electronic? Did you need more or less employees to do your billing after implementing an EMR?

I guess it would also be important to know if you decided to go with an integrated Electronic Medical Record and Practice Management System or if you tried an interface between your legacy system and a new EMR system.

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I get a bunch of email from all sorts of electronic medical record vendors telling me about their software and their company. I don’t mind when people contact me with something innovative and interesting. The problem is that most company press releases are all the same. They all tout the more or less the same feature set of every other emr company out there. I’ll put an example press release I got below so you can see what I mean.

At the end of the day, reading press releases like the one below I wonder if 1. companies understand what it gets bloggers and media to use their press release and 2. emr companies have really stopped innovating the way they should.

On the first point, if you want me to write about you or your company then you better tell me something cool and different. Sure, add in the list of standard features at the bottom, but sell me on a feature that makes you better than every other EMR company out there. Otherwise, I’m just going to ignore you as one of the other on the long list of EMR vendors. You’ll notice I didn’t even put a link to the company whose press release is found below, because there’s nothing interesting or unique enough about the company in that press release that makes me want to send people to their website.

As far as the second point, it’s been a while since I’ve seen some truly creative and innovative thinking from an EMR company. I’m talking about things like Medtuity’s granular method of data entry or Brendon’s beloved eMedRec which is a really interesting hybrid of a scanning/document work flow with some of the EMR features layered on top. I’m sure there are more cool things being done with EMR, but it gets lost in everyone needing the standard boring features.

So, keep the emails coming, but make them interesting so I don’t just go straight for the delete button.

WITH MTBC, THE LOCAL DOCTOR’S OFFICE FINALLY JOINS THE PRESENT – AND FUTURE – OF HEALTHCARE IT

New integrated IT system provides patient scheduling, touch-screen check-in, integrated records and billing with mobile access, real-time adjudication of insurance claims and more

SOMERSET, N.J. – Sept. 9, 2008 – Unable for years to match the cost-cutting IT advances of deep-pocketed insurance companies and hospitals, private physician practices are now embracing a level playing field with innovator MTBC.
This playing field extends throughout the patient-physician-insurer continuum, from the Internet to the paperless doctor’s office, creating enormous efficiency for all involved parties—even the pharmacy and medical laboratory. Through MTBC’s integrated system, patients schedule appointments online, receive automated reminders by phone, and check in at the doctor’s office at a touch-screen kiosk.
“Technology becomes far more dynamic as it enhances the patient-physician relationship,” said David Rosenblum, president of MTBC. “Our newest services reduce the time the patient spends in the doctor’s office and increase the care the physician can provide.”
Patients whose physicians use MTBC can schedule appointments privately with their doctors on a secure web site, while viewing available blocks of time. The reason for the appointment and medical symptoms may be entered, along with current insurance information. The patient will receive automated reminder calls prior to the appointment, minimizing no-shows—a bane of most doctors’ offices.
At the doctor’s office, the kiosk scans a patient’s insurance information with a swipe of a card and then conducts a brief survey of medical questions. This information is integrated into MTBC’s EMR software for easy access by doctor and staff.
During and after the appointment, doctor and staff enter notes, diagnoses, and prescriptions into MTBC’s EMR software. Prescriptions are transmitted by electronic fax to any pharmacy—handwritten prescriptions are obsolete. Lab reports are also electronic, accessible securely by the doctor on the web.
Insurance claim data, such as procedure and diagnosis coding, is entered and transferred securely via automated synchronization on a daily basis to MTBC’s web-based billing platform, with its real-time financial reporting and array of practice management tools. MTBC’s dedicated teams in billing, practice and patient support complement the cutting-edge service package.
After the patient examination, MTBC will determine exactly how much of the visit is covered, and how much the patient needs to pay out of pocket, thanks to Real-time Adjudication (RTA), a new service spearheaded by certain insurance companies.
MTBC’s system means no more waiting in a doctor’s office for hours due to poor scheduling practices. It means having the physician know what the problems are the moment the appointment begins. It means no more uncertainty or confusion over insurance payments, avoiding the unpleasantness of an unexpected bill that arrives weeks later.
And for the physician, MTBC creates a streamlined scheduling and billing system that allows substantially more time to be spent on the patient’s needs and questions.
“These advances demonstrate that we’re a nimble technology company that acts quickly on the issues reshaping the entire healthcare industry,” said Mr. Rosenblum. “We are always committed to maximizing and accelerating our clients’ collections.”
MTBC’s system integrates several advances in healthcare IT—previously available only at hospitals or insurance companies— to revolutionize private practices:
· Doctors migrate to MTBC’s free EMR (electronic medical records) software and slash records-related administration.
· MTBC provides access to real-time adjudication (RTA) of insurance claims for patients with UnitedHealthcare insurance, greatly accelerating related payment.
· MTBC recently launched the PDA version of its billing platform so that clients can access their practice’s financial reporting, claims data, and scheduler through an iPhone, Blackberry and Windows Mobile device.
· MTBC is now rolling out physician web sites that allow patients to schedule appointments online.
· MTBC conducts automated phone reminders to patients.
· MTBC is integrating a detailed survey program that patients can access online when an appointment is made. This survey gives a physician a better sense of the patient’s symptoms before the appointment even begins. And unlike other companies that have started to offer patient survey services, MTBC does not sell patient information to third parties – everything is kept confidential between doctor and patient.
· MTBC is testing patient kiosks that read a patient’s insurance card, take his or her picture, and conduct brief medical surveys. This will dramatically reduce waiting times and bottlenecks in physician offices.
“We’ve always been committed to bringing state-of-the-art technology to private practice physicians and practice administrators,” said Mr. Rosenblum. “Our business model makes all these innovations easy to use, integrated, and remarkably affordable.”

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Lately, I’ve been getting a ton of traffic with people looking for Dragon Naturally Speaking 10 Medical (DNS 10 Medical). Well, in honor of the launch of DNS 10 Medical, here’s this video that all doctors should appreciate if they’ve used Dragon Naturally speaking in the clinical environment before (even if the final “doctor” does a bad job acting and feels like he’s trying to sell the software).

If anyone else wants to do a review of Dragon Naturally Speaking 10 medical, please let me know and I’d love to have you do a guest post on it. Especially in the context of Dragon Naturally Speaking 10 medical being used in an EMR.

Thanks Eric for pointing me to the movie.

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I’ve always been intrigued by the idea of software like Lo Jack that helps you find your laptop should it ever get stolen. The biggest problem of course is the cost associated with the software. Today I found an interesting Open Source system for tracking and recovering stolen laptops. I haven’t had time to try the software yet, but this is definitely going on my to do list of software to try out.

How many times have we seen reports of a laptop stolen that had an entire database of personal or health information being stolen. Way too much. This could be an interesting and free solution. Even the best coded EMR software usually leaves at least some traces of PHI in Windows temp files for example. A free way to recover the laptop would be very beneficial.

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NaturallySpeaking (Medical) Version 10 is now available. Have any of the EMR and HIPAA readers used DNS 10? I’d be interested to know people’s reviews of DNS 10 as compared to 9. Luckily the upgrade is relatively inexpensive to go from one version to the next, but I’d be interested to hear people’s experience with DNS 10.

One of my blog readers already did their KnowBrainer 7 page pictorial preliminary review of DNS 10. Too bad the pictorial review is a pdf file. Also, that review is pretty technical, so if you’ve never used DNS before, then I wouldn’t suggest reading that review.

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I’ve recently been rather critical of Practice Fusion’s free EMR offering. I honestly don’t think that any of my feelings have changed about their offering. However, here’s a part of their press release that at least shows they’re getting some traction

Practice Fusion, the leader in free, web-based physician practice applications, announced today the addition of 1,300 medical professionals since its launch in November of 2007 and is currently serving more than a quarter million patients.

That should be a large enough sample size to get some interesting feedback about the product. The question is whether the product is really that good or whether the people at Practice Fusion are just great at marketing. Granted, marketing a free product is easier than getting people to pony up money. It will be interesting to see if their revenue model is sustainable. The problem is that a doctor’s office won’t know if it’s sustainable. I’m still not sure I put my practice on the shoulders of an unproven model. At least not yet.

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