Doctors are not Clerks

Sometimes in IT, you see glaring problems that seem so simple.  And then you look a little closer.  That's where I was when a nurse friend of mine was telling me about how the doctor she worked for had broken 3 keyboards, gave up his vow not to cuss, and was missing his beloved Kentucky basketball games.  The reason why?  "10 years of school, 14 years of practice, and now I'm a clerk".
Electronic Medical Records - Gotta get there
Don't get me wrong. I am a very pro-EMR guy. I am an evangelist for electronic medical records and networking information together, personal health records and all the rest. The cost savings are real, and the impact of connecting all of these "islands of information" on patient care can make a real difference.
I've read some articles lately where isolated issues of mistakes and security have been problematic. Two things will always be true in computers, Garbage in - Garbage Out. And the computer only does what it's told to do. In other words, the issue isn't the digital record, it's the implementation that messed thing up.
With that background, I guess I look at EMRs the same way. If you look at the statistics about EMR adoption, EMR that have been disposed of, and EMR impact on physician productivity - the numbers are staggering. And embarrassingly poor.
But why are the results so bad?
I'm not going to get into all of the issues, but one that just seems so straightforward to me. Yes there are exceptions, but for the most part, EMR vendors have justified their price by selling the elimination of transcription costs. Then they rip the tape recorder out of their hands and give them a keyboard. Sure, there are pull downs and decision trees, with point and click, and tablets. But for the most part, the EMR has taken mobility away, and turned the most expensive person in a practice and turned them into a clerk. By the way, that very expensive clerk is also probably the least efficient computer user in the office.
So let's trash all the EMRs and stick with paper, right? Of course not.
Voice Recognition -Part of the Solution:
Yes, VR has had some fits and starts too.  And when I use my voice dial on my cell phone and say "Call Mike Davis", it comes back with "Calling Pizza Hut".  Grrrr
But like anything, the allure of a gazillion consumers drive VR companies to solve that market.  One that shows up int healthcare is Dragon. A great software package which does a terific job of turning voice into text, right there on your screen.  But here we go again - the doctor is now editing his/her own jobs.  Again the doctor is a clerk.  Further, there are lots of support issues anytime you load consumer grade, machine-based software, into an enterprise environment.
More importantly, how does the document really fit into the workflow of clinical documentation?  How is it returned?  Networked?  Shared?
Do EMRs have Voice Recognition?  Sometimes.  But usually they suffer from being poorly implemented and it's obvious that they're bolted on, and not really part of the normal, natural design of the product.
So, what's the answer?  Embrace Integrated Dictation

Ultimately, EMRs/EHRs and the rest will solve this issue with some emerging technologies that allow for voice recognition with "chunking", and tagging data. But there are answers today.  One of my clients, VocalEZ, clearly understands the issues, because their founder grew up in this very specific space, and set out to design the solution with the individual practitioner at the base.  By integrating into whatever systems (PM, EMR, paper) are in place, VocalEZ can leverage all of the scheduling, referring, and demographic information in the systems, and slide right into the existing doctor work-flow. And by utilizing a Speechmike, which looks and acts suspiciously like a digital recorder, or a mobile device, the doctor can dictate just like always.  While they go see the next patient, the job is processed by some very robust VR software (up to 99% accurate). and ready for a staff member or contracted resource to edit, and it's automatically returned to the designated task basket, file server..Net result - Doctor is a Doctor, and the transcriptionists become editors that can be more than twice as productive, thus cutting costs and time dramatically. So, if you don't have an EMR, and are holding off because of all the reform uncertainty, this is your bridge.  If you have an EMR, but are struggling with adoption, this is your driver.
When I learned about VocalEZ, I felt like the guy at Chrysler who said "why don't we put a sliding door on the driver's side of the vans too?"





 

Offshore Medical Transcription - Still Worth the Risk?

For the past year I have been working on a project with a partner in the UK for the NHS. Throughtout the process, I've done extensive research on the competitive landscape, and found myself looking way beyond the simple cost equation that many think of with MT, which they view as a commodity.

Let's deal with reality:

The need for clinical documentation is not going away.  Even the EMR companies are conceding that transcription is still a critical piece of the equation.  I'll save my rant on Voice Recognition as the enabler for EMR for another day.   For now, let's just assume that there is alot of work to be done, and not enough medical transcriptionists in the US or UK to do the work in a traditional model.  Add rising demand to shrinking resource, and you get rising costs - or...opportunity for a new player to change the rules.  Like other aspects of IT, outsourcing, offshoring, outasking, whatever you want to call it has created enormous investment and development in countries like India, the Philippines, and several others.

It is what it is:

Right, wrong, or indifferent, we are all now accustomed to working thru endless telephone system mazes and extended hold times, only to be connected to someone we cannot understand.   The companies who have sent there service and call centers overseas have done it for a reason - to drive down costs and be more competitive in the marketplace.

The same has happened with MT.  And for a handful of years, alot of companies grew dramatically with this model and were able to leverage technology and a less expensive labor component to grow their business.  And customers, looking for savings, made the jump.

Changing World:

But now, those same companies that utilize offshore labor are feeling the bite of the changing global marketplace.  MT is not returning the margin it once was, and those invested overseas are looking at ways to leverage those English speaking workers into a higher margin business, such as Call Centers.  Make no mistake, this in not to bash the offshore workers.  But the shrinking margins have led to more competition from other applications, making a tight labor market even tighter.  The result is a higher costs, slower turnaround time, lower quality, and frustrated customers.

Today's Reality:

I could go on discussing costs vs production sacrifices,  but I'll let you look at the financials of the large MTSOs out there to reach your own conclusion.  I won't get in to broken English, natural disasters or the political and business dynamics of working in these countries.  To me - one issue trumps them all.

As we all drive toward EMR, EHR, PHR, and all the other TLAs (three letter acronyms) of the community health networks, the overriding concern must be security and privacy.  In the US we have HIPAA, and Europe has it's own Data Protection legislation.  And yet we hear again, even this week about medical records being for sale in India.  Or the story about an MT in Pakistan threatening to post a California hospital's record online because payment was not received through a long line of subcontractors. How can a hospital administrator really afford to take that risk?  Is there really regulation that includes verification, Chain of Custody, and real enforcement? 

Bottomline:

I would contend that a health care provider has a sacred obligation to protect its medical records.  This is not talking someone through how to solve a PC problem.  Obviously, the industry is paying attention.  Stronger HIPAA regulations are on the way, and MTSOs are all taking different directions in trying to deal with the shifting sands.

My take - the ones who utilize a comprehensive Voice Recognition process, (read - not just a tool or Dragon), to drive productivity in their primarily US-based workforce, will win the day. 

Wondering if a Blog has an ROI

So here I go again, writing a blog.  I've played with this idea before.  I've done a few, and then I get too busy and stop.  I wonder the same thing about Twitter.  For the past several months I've done a variety of activities to determine whether there is any real value to spending time I don't have to do this very thing,
Well, I'm doing it, so I guess I see enough value to keep dabbling.  And over the past months I have come to learn that there are many great uses and absolute directed revenue that is derived from social networking.  Having said that, I believe that 90% of the tweets and blogs do not have a Return on Investment.  And that's OK,  As long as you take a realistic view of the outcome.
To be fair, I am not a social networking guru.  I don't have a huge marketing staff researching latest trends and tools and strategies.  But I am also not a guy who is addicted to Facebook or Twitter, nor do I think anyone cares what I ate for lunch.
I have however found real value as I've dabbled in this arena.  Specifically here:
1.  Research - What a great way to get realtime, current, feedback from folks on just about any subject.  What a great educational resource to watch how Microsoft has launched 7, or Google Voice, or you name it.  And then the point-counterpoint conversations that arise from real users,  Yes, I know they are not all who they pretend to be.
2.  Relationships - How else would I ever get to have a direct conversation or exchange with some of the most influential and visionary folks around the world.  It so helps from being in the cocoon of a large corporation and prevents group think.
3.  Global Thinking - I'm an IT guy.  I'm a healthcare guy. Solutions I look at have so much play around the world that it helps me think globally.  It's shocking how similar some of the challenges are in underdeveloped countries to the US.  A doctor in Iraq for example is an island of information. Is that any less true in the rural US?  When you show up in the ER, does the doctor know anything about you?
4.  Hearing the message - Sometimes I hear myself say something or see what I write - and it just helps me cristalize my message.
I will be exploring many issues in coming posts and commit to sharing with you my learnings along the way.

Follow the Money

I've been involved in countless projects over the years involving millions of dollars and companies of all sizes in many verticals - as a vendor, as a buyer, and as a consultant. Rarely have I encountered a vendor, who truly knew how the client was evaluating the options. Sure, sometimes that is intentional. Probably more often, it's because he/she never asked. Customers too, are naive about how decisions work within their vendor's world. What can be negotiated? What is sacred? The result is often a contentious contract dialog that ends up with hurt feelings and bruised egos on both sides. Not a great way to enter into a relationship.
Let's make it even more real. Many client and vendor teams don't really know how or why decisions are made in their own organizations. Who seeks to benefit from the decision one way or another? Who takes on more responsibility? What politics and relationship dynamics are in play?
One more progression. If it's commonplace that neither the vendor nor client representatives really understand the decision-making process, they certainly aren't following the budget choices that created the opportunity in the first place.
Allow me to help - very succinctly. Follow the money. I know it's basic, but it's true. The entity reaping the benefit - will almost always (read should) pay the bill. Is there any mystery here? Is this some great and wise truth - of course not.
And yet... many Washington are ignoring this. Yes - I could go a hundred ways from here but I will restrain - and focus on just one.
President Obama plans to make electronic health records a priority in his first term. He plans to invest upward of $10B per year for 5 years. If it's anything like every other initiative out of Washington - that number is just the ante. More importantly who will get the money? How will the money flow thru the marketplace? It's like these so-called Stimulus bills Congress is passing. Has that money actually been used to impact individual taxpayers - or just pay bonuses and refill the coffers? (Sorry, I digress)
EMR/EHR - who is the beneficiary? Who is paying for it? To whom is the money going? Is there any tracking to show that the funding actually went where it was supposed to? How and when are the returns expected?
Don't get me wrong - I am a huge advocate for getting healthcare into the information age. But there are many questions, and I worry that those providing answers have an agenda. Privacy issues aside - the money trail here needs to be closely monitored or we'll have another Fannie and Freddie crisis.

Think Globally, Act Locally

My last post dealt with the idea that the little guys would drive innovation and technology in the new economy. I think there is sufficient evidence to support that claim. But one of the great challenges to any new technology or service is the ability not only to market and sell the solution but to implement and ultimately support the solution throughout it's lifecycle.
Certainly I am an advocate of SaaS, ASP, Wed 2.0, Cloud Computing... based largely on the fact that support moves away from the user and into an environment where the expertise is abundant and available. As we move further down the road of the large companies retreating from direct local support of customers, the issues around implementation and support will only become more apparent.
How does an enterprise respond? It doesn't look like adding staff is going to happen if you look at the job reports. Calling a contact center and struggling with language barriers may be acceptable for minor issues, but I'm convinced that the best way to deal with these kinds of issues is to find a trusted local VAR, Integrator... These folks can essentially be part of your staff. But they get paid by the vendor of the solution you are acquiring.
What about the manufacturer, software company, or service provider? I can tell you from the many client I have in this arena - they realize that they too need these local VARs and Integrators. An example is SIP Trunking. A very cool VoIP service that can save clients a ton of money. Think Vonage for Business. The problem is how do the SIP Trunking providers get the solution implemented? Who can do that? One of my clients tried to implement it on their own, only to spend as much engineering time implementing and supporting the solution that the costs advantages disappeared.
So let's look at the latest craze - getting everyone's medical records available online. There are obvious cost benefits to the entire health system from providers to payers to consumers. President-Elect Obama would like this to happen in the next 5 years - with staggering costs to implement these EMR/EHR systems.
There are some tremendous solutions out there to help facilitate this move. The ones who can maneuver through the implementation and support barrier will have a great advantage. Obviously, those platforms that are supported in the cloud, will lead the way. But EMR/EHR systems can be very complex and almost certainly will necessitate the need for local expertise.
My Take:
if your an enterprise, a clinic, practice - start asking around and searching for a local resource you can trust. Meanwhile there are some great web-based solutions out there to help bridge the gap.
If you’re a solution provider, make sure you have a network of partners to support your business plan.
If you’re a VAR or Integrator - get up to speed and recruit best in class solution providers.

A Collection of Little Guys

As I research various technologies and companies for my clients, it becomes more clear to me that we are far from the days where the corporate giants will lead the way into the future.  Remember the days of "no one ever got fired for buying IBM".  Or when you had network issues it was a simple call to your local (read not 800# in who knows where) AT&T team.

I'll save the support and impact for another day.  Don't get me wrong, the new world is exciting and dynamic.  It allows all of us that contagious energy of a start-up.  It means that a 14 year old can create a leading browser.  It means a guy in his basement can beat a $50M company to the punch.  Most of all, it means that the little guy can compete.

In his book The Innovator's Dilemma, Christensen demonstrates how disruptive technology can cause "great firms to fail".  That book came out 12 years ago.  I think the next evolution of this idea is being played out today.  Not only are new technologies changing the landscape, but they are being created not just by other large companies leapfrogging, but by small businesses, or start-ups - individuals even.  How cool is that?

Go to your local Panera, or Atlanta Bread, Starbucks - on any given morning and you will see the folks driving the bus in the new economy.  They are the entrepreneurs, idea guys, and have a passion and hunger to make things happen.  And for each one of these morning capitalists there is  an army of creative types online late into the night.

Will the large companies fail?  Many will.  Do they still have a tremendous advantage in sheer size, funding, and talent?  Absolutely.  Can they recover from being late by throwing resources at a problem?  They do every day.

But the little guys have no boat anchor to drag around.  No ship to change course.  No meetings to have meetings to put together a committee to study to change.

People talk about President-Elect Obama and his agenda and worry about the redistribution of wealth a la Joe the Plumber.  I think the combination of the economic crisis we face today, coupled with the ever-increasing speed new technology development  - will impact our corporate world more than any socialist agenda or any other government action.

Never has there been so many, highly talented folks working outside of the "big companies" our parents worked for, or that we started out in.

I'd love to hear stories you know about these "little guys" changing our world.