Wednesday, September 15, 2010

Do EMRs increase clinic or hospital profits?

What is the most common question asked by Doctors and Hospital Administrators when they meet me? Safe to say it is quote unquote: How does implementing an EMR solution increase my clinic/hospital profit?

Now first let’s go into the economics of the whole thing.

Profit = Revenue – Cost

So to increase profit an EMR needs to either increase revenue or decrease cost, and also factor in its own development, implementation and training costs.
So let us look at revenue first:
A good EMR system can drive revenue up in following ways:

1. Cause: Better customer service
SMS alerts, Quick Generation of reports, No confusion in terms of appointments, neat printed prescriptions, Doctors more attuned to patients with their complete history available, Emailing of reports
Effect: Patients keep coming back to you due to their pleasant experience, they develop a fan following and also recommend relatives and friends thereby driving up revenue.

2. Cause: Better Management of Time
Quicker access to Patient History, More Accurate Appointment schedules, Quicker Generation of Reports, Easy one Click Generation of Management Reports and Statistics
Effect: Man Hours saved by Doctors, Nurses and Attendants can be effectively used to see more patients’ thereby increasing revenue.

3. Cause: Minimizing Errors
Accurate prescriptions, Better Access to History, Improved note taking, Auditing of stored information
Effect: Less time spent on un-doing errors, less chances of revenue loss and time wastage on medico legal cases.

4. Cause: Portability and Access
Online Appointments, Online availability of EMR, Online Access to reports by Doctors, SMS and Email Communications
Effect: Access over the Internet to Patients and Doctors increases work time, provides more avenues for patients to interact with the hospital or clinic thereby potentially increasing revenues. E.g. Charging Patients to access their records online, or Doctors giving reports in quicker due to online access.

5. Cause: Offering More Services
Online EMR, Patient History Printouts, Fast Insurance Clearances, Multiple Doctor Schedules
Effect: New Services offered can be charged increasing the revenue streams

6. Cause: Better Decisions
Unpaid Bills Reports, Daily Registers, Medical and Administration Statistics
Effect: Where is your largest revenue coming from, which service, what kind of patients, which days, answers to all these questions which are now at your fingertips lets you plan better to increase and maximize revenues?

Increasing revenue is just one end of the bargain. The other is saving costs! How?

1. Decrease Staff Size: A good EMR system lets you maximize your efficiency especially on the administrative end. This lets you streamline your staff activities and in some cases even reduce staff.

2. Generating Important Reports: Report on Unpaid bills let you call the requisite clients to follow up and recover the money, a time consuming affair on paper. Or important statistics on schedules lets you find the bottle necks in Doctor Timings and improve the scheduling, decreasing losses to the setup.

3. Save Paper: Less work is done on Paper leading to long term benefits and gains.

4. Save Space: Less paper means less storage space required. Use the clinic and hospitals to provide new services or better service.

5. Manage it all: A good EMR allows you to manage your practice as well, integrating basic accounts and inventory to prevent losses, theft and effective reminders when stocks or balances run low.

Now for the down side, what costs are attached to the EMR?

a. Development: For a customized solution or a product you will spend on developing vis-à-vis buying a ready product, this is the direct sunk cost.

b. Hardware: Choosing a good EMR can greatly reduce this cost, but this too is a sunk cost.

c. Training: Time and effort required in training the staff and migrating to the new system takes time and since time is equal to money there is a cost attached to this.

d. Upgrade and AMC: Support costs are also involved with any software, so is upgrading it to newer versions. But this is vital to pay, because in the long run, PC problems do crop up and its best to be protected.

In the long run however, the ROI on a good EMR system can be tremendous.

Our product case studies for our Clinic Management Software Clinkare showed that a doctor using all the features of Clinkare in a multi-user setup can save upto Rs 15000 per month directly and in man-hour estimates.

But nothing will increase your Profit as much as using all the features of an EMR in a proper manner and fully utilizing its potential. The real value comes when you are ready to work with the EMR and not against it, when you can understand where all it can help you, increased profit is then certain.

Tuesday, August 10, 2010

Patient Safety

Few Sundays ago we were privileged enough to be invited by Dr. Nikhil Datar, a pre-eminent gynecologist and medico-legal expert to witness his premier talk on Patient Safety. It was hosted by IMA Dombivali and had a strong audience of over 40 doctors waiting to hear Dr. Datar’s talk. Dr. Datar had recently returned from UK where he attended a program organized by WHO on Patient Safety. Plus91 Technologies believes in making patient centric solutions which don’t just automate the clinic or hospital but also improve quality and service. Keeping this in mind, the presentation was interesting not just for the doctors but also for us.

The doctors were interested in the talk, intrigued by what new information can they hear. It started slowly but filled with practical examples the doctors soon were eager to know more. More than that they realized in their own practice they need to reflect and close loopholes so that they ensure patient safety. The doctors really got involved with questions, interactive cases and videos. We think they all walked out little bit wiser. As a software company involved in Healthcare, we think patient safety becomes a vital cog in what we are doing and it works at multiple levels. 1. Creating solutions which ensure and promote safety, 2. using the patient safety angle to promote such solutions which benefit the doctor in many more ways, but they finally see it as useful when something hard hitting as this is spoken about and 3. Increasing patient interaction and service allowing patients to feel safer and learn on how they should protect themselves too.

So what all does patient safety entail? It covers a lot of ground from something simple like washing your hands before a physical examination to something complicated as giving instructions during a high pressure surgery. They key learning was awareness that things can go wrong and improving communications and processes to prevent minor errors from becoming major issues. Simple techniques like reading medicine names allowed, using color coding on various instruments, storing patient records in a neat and systematic manner help provide better quality care to the patient. We think from hearing his talk, the biggest initiative one can take in improving patient safety is increasing ones awareness in their surroundings. Being aware of the possibility and the effects of your actions goes a long way in preventing mishaps that can happen. Some major inferences were: Out of the 3.7% cases, only 1% could be called as negligent, 50% of these are preventable and most notable – majority of them were not individual failures but the system failures.

We think a lot of good work is now being done in this field by numerous players. The ones which Plus91 Technologies is directly involved with include Dr. Nikhil Datar an epxert in the field, PIET (Patient Information and Education Trust) and NGO, PEAS (Patient Education and Awareness Series) who make wonderful videos and content driven education material, HELP (Healthcare Education Library for People) which have seminars weekly apart from the actual library initiative and Dr. Malpani who is organizing a conference in October in Mumbai exclusively dealing with Patient Safety. As technology pervades healthcare, we can already envision so many places where Plus91 can actively help improve patient safety standards. The possibilities are exciting not only in their scope and challenge but also because this is probably one place we can actually be able to claim we saved a life and that thought gives us a tremendous boost.

Monday, August 2, 2010

Improved Patient Safety Using Software

Patient Safety is a vital aspect of healthcare. With a fairly large number of indirect deaths and also potentially life threatening situations resulting directly from lack patient safety it becomes a vital cog in the healthcare machinery. Software products are introduced in any setup to increase efficiency and accuracy, both important factors when trying to improve safety. I am going to highlight some basic examples how inherently as well by actual design patient safety measures can be improved through normal Electronic Medical Records or Practice Management Software.

1. Prescriptions and Medications: The most common errors are seen when doctors write prescriptions on paper and the patient or the chemist misread the prescription. This is a common occurrence and a printed prescription generated from software with already present Drug Data is the safest bet against such a mishap. Other errors which can be prevented include, mistakes made by doctors in writing the dosage or strength, which in software can be fixed to prevent wrong entries, also a check on concomitant medications interfering the drug can be done. These features are already present in the Plus91 clinic package Clinkare. Ensures no errors happen due to differing writing styles or hand writing.
Another neat feature is sending reminders to the patients/nurses to take the appropriate medication at the correct time via SMS. This ensures no missed dosage which could have lead to problems. This feature is available in ClinION the hospital management solution from Plus91 Technologies.

2. Patient History: Doctors in a hurry, if patient comes without papers can prescribe the wrong treatment in case the data is not properly documented. It is vital to know previous visit experiences which can help the doctor make a better decision. Almost all softwares allow storing overall patient and current complaint history which helps doctors make better and more accurate decisions thus ensuring patient safety. This feature ensures that reliance on memory is less!
In the new age software patient history can also be coupled with Clinical Decision Support systems to help the doctor make his or her decisions in a better and more accurate manner.

3. Patient Data Entry: This is an exclusively software based point. Accurate entry in the system can be ensured by various validation measures and checks. This may slow down the process but a good process ensures the software protects the basic problems that can happen. Some key examples are: a. Validated fields which take only certain values and anything outside throws an error, b. Every time a new page is opened or traversed the patient name is popped up to double check the correct patient data is being filled in, c. Two person check entries at very vital and critical data entry points (used often in clinical trial data management), d. SMS or Email alerts in case of a vital sign going outside normal range at the ICU

4. Consent Checks: A patient must know what procedure they are undergoing, the risks and also most importantly dos and don’ts. A software can for all the procedures ensure that the consents are filled using a reminder / validation system to ensure the patients have been given the once over either by the doctor as a series of questions and answers which are entered in the system or using a video/presentation format with a consent thumbprint or electronic signature taken at the end. This is vital so that the patient does not make mistakes because of not knowing he or she had to come empty stomach for a procedure.
Plus91 softwares automatically allow you to link vital consent forms to various tests, procedures and consultations and remind you to get them filled.

5. Check lists: The Indian Born adviser to the American President on Healthcare issues is Dr. Gawande just released his new book “The Checklist Manifesto”. A checklist is the doctor and hospital staffs most trusted friend. Often negligence cases leading to patient safety mishaps happen because proper procedure was not followed. Many types of software come with check lists which need to be marked as complete before the next screen of tasks can be accessed. This ensures that all important steps are carried out and in order.
Checklists can be determinate that is fixed in nature like an inventory for a particular type of surgery. Some check lists can be flexible, like an in house patient prescription check list or schedule followed for an entire ward. Using software both can be checked and managed without a fuss.

6. Improved analysis: Software allow us to collate all sorts of medical data, this data can now also be analyzed to make future decisions better. Knowing what kind of patients react to which medication, or which months cause more complaints of a particular type of disease or maybe information on which doctors have better recuperation rates vis-à-vis their treatment methods all allow the healthcare system to better prepared for future patients.

Wednesday, May 12, 2010

As a Doctor I want to use technology to be able to … an Indian perspective…

As we improve our software products and work with more doctors, we are learning a lot about what doctors in India want from information technology . How do Indian Doctors view IT as an enabler ?

In theory, one would expect doctors to want to use IT for the following applications.

1. Computer Based Medical Records (EMR)
2. Clinical Information Sharing Networks
3. Clinical Decision Support
4. Administrative Functions – Accounts and Patient Profile Management
5. Computer Generated Prescriptions
6. Better Patient Communication and Care

However, what the practicing doctor wants in real life is quite different !

So what does the typical doctor’s list look like?

1. Accounts and (Mis)-Management

Indian Doctors give a lot of importance to accounting in their Clinic Software; they expect the package to bill as per their requirement. Unfortunately, because many of them do not always want to declare all their income , they want the software to provide “deductions” . We have to educate them that a good package will help them to improve their cash flow and collections by allowing them to track their patient inflow so that they know what business they are generating on a regular basis. Intelligent software will help to prevent embezzlement and will discourage the office staff from pocketing the doctor’s hard earned money ( which is easy to do , since this is still a predominantly a cash business today)

2. Referrals Management

Referring patients to specialists and other clinicians is a common practice the world over, but in India it has an additional financial angle. Doctors want to know how many patients they were referred and by whom, so that they can make the necessary payments back to the referring doctors.

3. Medical History

Doctors want easy access to their patient’s information to help them make better medical decisions. While they are happy about the fact that the software gives them instant access to the patient’s medical records, they are still reluctant to use clinical decision support tools, as they would rather depend upon their clinical ability, than use a computer .

4. MIS ( Management Information System( Reports and Patient Registers

MIS reports and registers are a commonly requested feature . Sadly the uninitiated ones forget that data first needs to be entered properly , so that it can be intelligently extracted. The reasons for the MIS reports are both noble (research purposes) and mundane (for filing income tax returns) .The biggest challenge here is designing forms and data capture mechanisms which give useful reports. Often , there is a big disconnect, when doctors design incomplete templates , and still expect to be able to generate relevant data ! . Garbage In = Garbage Out !

5. Custom Designed Templates

Plus91’s software has designed so that doctors can customize their own templates , to suit their personal preferences.. Doctors love this feature, as each one wants to design something as per their own workflow.

What of the future ? We hope that as the Indian doctor matures and becomes more comfortable with using IT, he will want the following features as well.

a. Clinical Decision Support

b. Computerized Prescriptions

c. SMS/Email alerts and reminders

d. Online EMRs

e. Insurance Claims Management

Plus91 software is already built to provide these enhancements, which will give a definite boost to the quality and efficiency of their practice , and also help them to improve their profitability.

Friday, February 19, 2010

Website For Doctors - Alive and Kicking

Website for Doctors is finally live and kicking, and after touching are first 10 clients within the first month of going live, it is safe to say the idea behind the venture is a solid one. Doctors have a business to run and need to provide high quality information to their patients to give high quality service. A website is a great medium to communicate with patients – and has now become a key tool for every doctor in private practice.
Why does Website for Doctors appeal to the doctors who are signing up? Because we are a specialized service, like a highly specialized clinic, serving only doctors. Since we focus on dealing only with doctors, we understand their needs and wants , so we can deliver what is best for them.
Every website we have done has gone live online within 48 hours of the doctor providing us with the required information. What’s more important is that after the doctor takes the first step of choosing a template and sending us his basic data, we can send him his personalized dummy site by the next day. Seeing it live and understanding that his clinic is now live on the web enthuses doctors to ask for more ! Seeing is believing !
What allows us to bond with doctors and give them the solutions which they need ?
Our specialization based galleries; our dedicated team ; and our medical domain expertise, because of the knowledge we have acquired as a result of developing our EMR products . A website can be tweaked and the content modified to give the doctor’s patients what they need from the website. A superspecialist consultant can get exposure to international patients; while a small city specialist can get publicity and provide directions to his clinic.
There is still long way to go in actually making Websites for Doctors from a doctor’s “want” to a “need”, but the process has begun ! Apart from the basic features of a website, there are some simple tools which can go a long way to improve your website experience for your patients. Our aim at Website For Doctors is to recommend these tools , such as health calculators, video galleries, online patient history forms ; customized ask the doctor queries; and google maps which provide directions to the clinic.
You can check out some of our work at
Some of our client sites include:,,
All these websites were ready in double quick time and to the satisfaction of these doctors. Even today we provide suggestions and accept them to tweak them to make them better. As Mercedes says “the road to perfection has no finish line” but it definitely gives us , and the doctors who have decided to take this journey along with us , a goal for the future!