Since first hitting the market in January 2010, the iPad and its successors have been somewhat of an anomaly in healthcare technology. Outside of cutting edge clinical treatments, the healthcare industry normally lags behind other sectors in adopting new technology. Not so with the iPad, which has become a favorite of healthcare providers in both private practice and in hospital settings. Why, you ask? Because the iPad bypasses a lot of the usual frustrations providers have with technology. The iPad is small, lightweight, fast to start, easy to use, smaller than a patient chart, can fit into some whitecoat pockets, affordable, tactile, and has thousands of healthcare-related apps available.
At the time the first iPad was introduced, John Halamka, HIT rock star and CIO for Beth Israel Deaconess Medical Center said “My general impression is that it’s not perfect for healthcare, but it is closer than other devices I’ve tried. It will definitely be worth a pilot.”
For the organized and busy professional on the go, the smartphone has quickly become a necessity on par with a persons house keys, wallet, or purse. The past five years have vaulted the smartphone from status symbol to must-have business tool by bringing data and communication capabilities from your office to the palm of your hand. With decision making and communication tools always at the ready, you can be productive from anywhere you are, and you are freed up to bring information to clients, meetings, and conferences without the hindrance of a laptop.
Physicians, practitioners and forward thinking healthcare organizations are leading the charge to embrace mobile health, often called mHealth, or the practice of patient care supported by mobile devices. A survey conducted at the physician online and mobile community QuantiaMD in May of 2011 found 83% of physicians reported using at least one mobile device and 25% used both a phone and a tablet. Of the 17% surveyed who did not use a mobile device, 44% planned on purchasing a mobile device sometime in 2011. Physicians surveyed reported their top uses for mobile devices as:
I’ve had a lot of questions since last week when I offered to help readers “get on the cloud.” Most people want to know – what exactly does getting on the cloud mean?
The term cloud comes from both the look of technical drawings which depict the relationship between cloud services and consumers, and is also a metaphor for the fact that cloud service providers exist out of sight in some distant location. My favorite definition of the cloud is “Using the Internet to store, manipulate and deliver data.” Here are 76 ways to do just that!
SECURITY & RISK MANAGEMENT
Decide user by user which files and folders each employee or stakeholder may have access to. Decide if the user may view information, upload information, download information, invite other collaborators or edit documents. Change the user’s permission instantly, or eliminate their access to everything on the spot.
Store critical documents: letter of incorporation, Tax ID assignment, Medicare letters, shareholder agreements, by-laws, etc.
Scan in any and all documentation of lawsuits and or legal correspondence about patients.
Collate logon information for important sites: CAQH, NPPES, PECOS, state board, specialty board, etc.
Collect all information needed for credentialing and privileges for all providers in one easy place: CV, photo, license, board credentials, DEA, state registration, malpractice, references, etc. Keep copies of all credentialing applications in the same file.
Keep a licensing and privileges spreadsheet for all professionals so deadlines don’t take you by surprise. Include CPR, ALSC, DEA, state licenses, and board certification and recertification.
Never worry if you’ve locked your office, your file cabinet or your desk again. Your information is safe in the cloud.
Store important logons and passwords on the cloud along with instructions and know that if something happens to you, the business will recover quickly.
Have employees watch for health fairs and special events that your practice can participate in. Develop a calendar for community events that you can prepare for annually.
INFORMATION SHARING
Share files up to 2GB (images, video, audio, text)
Turn a folder into a public web page.
Start a secure referrers’ area and give access to those practices that refer to you. Stock it with FAQs, referral forms, maps and directions to your practice, and phone numbers and emails for communication. Keep a referrer satisfaction survey on their pod at all times.
Push the patient schedule into the cloud so any provider can check their schedule at any time from anywhere.
Store building or suite blueprints.
Develop a practice glossary to document all abbreviations and specialty-specific terminology – very helpful for new employees and transcriptionists.
Make a secure education area for your patients which they can access from your website or in your waiting area on iPads. Include websites, blogs, patient satisfaction and other surveys, health tracking programs, etc.
For those providers on productivity bonuses, push a productivity report to the cloud for them to review privately.
Put staff education programs on the cloud for new employee orientation and annual training on compliance, OSHA, HIPAA, fire safety and disaster communication plans.
Post photos of the office picnic or Christmas party, or the new baby, or the bride and groom.
Use the cloud as a digital scrapbook of events, new employees, new services, accolades, advertising or publicity.
Pass around a digital birthday greeting card to all staff except the one having the birthday!
Post a job on craigslist. Once you have a group of candidates you want to consider, give them a link to a folder with the position job description, benefits schedule and in-depth information about the hiring time line.
Post lunch menus for restaurants and take-outs within several miles of the practice so employees can get lunch efficiently and quickly.
Post the office schedule for the year showing which dates the office will be closed for holidays.
Post the call schedule and let your answering service and the hospitals view it.
Publish your weekly practice newsletter on the cloud – it becomes an instant record of when and how things were communicated.
BUSINESS MANAGEMENT
Scan invoices to the cloud for storage once you’ve paid them.
Scan invoices to the cloud for an external bookkeeper to access and pay them.
Scan invoices to the cloud for a physician to approve them for payment.
Scan the daily accounts receivable work (EOBs, checks, deposit slips, denials, reconciliations) to the cloud and shred the originals at the interval of your choice.
Scan documents to the cloud when you are notified that employees are having monies withheld from their paychecks for child support or garnishment, or when they change their deposit information or retirement plan contribution.
Track the history of files and folders – when did we change this policy? When did we go to this compensation system? What was the original wording of this contract?
Generate reports on employee productivity, looking for patterns of collaboration and innovation.
Scan RAC, CERT, ZPIC and other audit letters when they come and keep a spreadsheet of dates records and appeals are due.
COLLABORATION
Have online meetings centered around documents in the cloud.
Post job protocols and empower employees to change protocols regularly as information and routines change.
Start a CME log for each provider that the providers can easily add to.
Have your employees collect stories, links and other items in the cloud to push to your Facebook page or website blog.
Keep minutes from physician meetings and request all physicians review, ask for changes and sign off.
Keep attendance and minutes from staff meetings and ask all staff to electronically sign the minutes.
Have each employee keep a continuing education log for face-to-face and online education.
Assign tasks. Place something on the cloud and assign staff to respond to it, change it, develop it or implement it.
INCREASE EFFICIENCY
Develop a “How Do I?” document for quick information new employees need to know and established employees may not remember. Some examples: How do I reach the inclement weather information line? What do I do if there is a blood spill in the practice?
For the manager – develop a staff roster with dates of hire, dates of birth, social security numbers, phone numbers, hourly wage and termination dates. One document will answer 25% of questions you have or others ask you every day.
Standardize protocols and information when you have multiple sites or divisions.
Show each employee how to keep their most-used files on their digital desktop to access without a logon and password.
Sync desktop folders to cloud folders automatically – documents are updated to the latest version without thinking about it.
Restructure your files and folders as many times as you want or need to. Rename files, move and copy files, and delete files if they are not serving the purpose you thought they would.
Expand the number of users instantly for special projects.
Put every form on the cloud, have employees complete them on the cloud, sign them electronically, then share them with you for your electronic signature.
Put new templates or forms on the cloud for everyone to draw from – eliminate old letterheads, logos, addresses, etc. instantly.
IMPROVE MOBILITY
Fax documents from the cloud to a fax machine.
Email files from anywhere.
Search for anything in your cloud by words or phrases. Never lose anything again!
Access the cloud from anywhere and from any device – smartphone, PC, iPad…
Put the patient schedule information into the cloud so if inclement weather hits, staff can access the schedule at home and contact patients about their appointments.
Access your business 24/7/365.
DAY-TO-DAY MANAGEMENT
Assign a folder for your CPA to be notified when financials are available for download, or for you and the physicians to be notified when s/he finishes the financials or taxes.
Assign a folder for your benefits broker to be notified when new employee applications for medical and dental benefits are available for download.
Assign a folder for your banker to be notified when quarterly financials are available for download.
Assign a folder for your physicians/owners to be notified when monthly or quarterly financials are available for their review.
Post practice calendars for paid time off requested and approved.
Develop a physician referral resource tool if your PMS does not organize that information well. Create your own spreadsheet with all the fields of information that are important to your practice and have all employees add to it and correct it routinely. Have someone in the practice or a temp or prn person call every practice/group on the list twice a year and confirm all the pertinent information.
Post a “Who Covers Whom” list that spells out who covers primary responsibilities in the practice when someone is out of the office. Building your team 3 deep (for every primary task, there are at least 3 people that can perform that task) is crucial for reducing vulnerability.
Video new employees answering a few questions about themselves and post it on the cloud for all staff to view.
Put video of all staff introducing themselves and telling what they do on the cloud for new employees to view.
Video benefit providers discussing benefits so employees can watch at any time – medical insurance, dental insurance, vision insurance, short and long-term disability, life insurance and retirement benefits. Employees will get more out of and become more aware of what their benefits are.
Make an easy-reference spreadsheet with the payer contracts listed and images of the plan cards for staff to be able to identify the contracts and plans in force at any given time.
Keep personnel files on the cloud. You may choose to have a file of documents the employee may see and get a copy of, and a file of documents they may not see or get copies of. Both can be a part of the same folder.
Store scripts for your messages on hold, your after-hours message and your scripting for employees.
SAVE MONEY
Increase storage space without buying any hardware or software.
Scan charts into the cloud as a preliminary repository before implementing EMR, or scan charts of inactive patients in so you don’t have to pay to store them offsite.
Never back-up your documents on your computer again.
Put your triage algorithm or flow sheet on the cloud. Hire nurses to triage from home.
If a manual doesn’t come electronically, scan it onto your cloud. Check the manual before you call the repairman.
Preserve your valuable employee knowledge – have each department develop a folder with the important resources for their staff. The billing department may have websites they refer to for coding questions, a primer on evaluation and management coding, a cheat sheet on standard practice fees, and a calendar for the times of the year that different updates and revisions to CPTs, ICDs and NCCI edits.
Steps to digging under the meaning of EMR certification:
Image via Wikipedia
Click to see the most recent alphabetical list (by product name not company) of all products certified here.
Find the company or companies you are using or are considering using.
Check that the exact name of the product is what you have or might purchase.
Check to find out if a module or part of the product is certified or if the complete product is certified.
Check to make sure the version of the product is the version you have or will have.
If you have questions about each company’s exact criteria met, you are in luck! On the ONC site here, you can click on each company’s detail (“View Criteria”) on the far right column labeled “Certification Status” to see what they have and don’t have. Compare this to how you are anticipating using your EMR to meet meaningful use. The more check marks a company has, the better-equipped they are (and more flexible) to meet your practice needs and to qualify for the stimulus money.
The ONC site with the Certified Health IT Product List (CHPL) is Version 1.0. Version 2.0 is now being developed and will provide the Clinical Quality Measures each product was tested on, and the capability to query and sort the data for viewing. The next version will also provide the reporting number that will be accepted by CMS for purposes of attestation under the EHR (“meaningful use”) incentives programs.
You can tell ONC what you think would be helpful in the new version by emailing your ideas to ONC.certification@hhs.gov, with “CHPL” in the subject line.
If you’d like a list of just outpatient/medical practice EMR products or just inpatient / hospital products, I’ve split the big list into two smaller printable lists here:
Remember that meeting meaningful use does not tell the whole story – if you are shopping for an EMR be prepared to go beyond a product’s certification status to consider:
Flexibility – does it make the practice conform to it or can it conform to the practice? How?
Templates and best practices – are you starting from scratch in developing protocols, templates and cheat sheets for your practice, or does it have a storehouse of examples to choose from or tweak?
Built for the physician, or the billing office, or the nurses, but doesn’t really meet the needs of all three? Make sure the functionality is not too skewed to one user group, but if it is, it should be somewhat skewed to the provider.
Interface and integration with your practice management system. Does the information flow both ways? Do you ever have to re-enter information because one side doesn’t speak to the other?
Interface with other inside and outside systems: Labs, imaging, hospital systems, ambulatory surgical center systems?
Built-in Resources: annual upgrade of HCPCS and ICD codes, drug compendium (Epocrates), comparative effectiveness prompting?
Mobile applications – EMR on your providers’ phones?
Data entry systems – laptops, notebooks, tablets, iPads, smartphones, voice recognition?
Hosting – in your office? at the hospital? at the vendor’s data center? in the cloud of your choice?
What’s the plan for ICD-10? Will they provide practice support and education for the change or will they just change the number of characters in the diagnosis code field?
Price, including annual maintenance and additional costs for training, implementation, on-site support during go-live, and additional licenses for providers or staff.
