Wednesday, August 24, 2011

What Is Telemedicine?

The American Telemedicine Association defines Telemedicine as "the use of medical information exchanged from one site to another via electronic communications to improve patients' health status."

The term "telehealth", "e-health" and "telemedicine" are often used interchangeably, the difference being that telemedicine involves using information technology primarily for the delivery of clinical services while telehealth and e-health also include the provision of non-clinical healthcare services like tele-education and tele-training for continuing medical education, practice management, research and administration.

Telemedicine is practiced when medical services like health consultations, diagnoses, procedures, patient report analysis, monitoring and so on, are electronically provided by practitioners to patients based in remote locations using telemedicine technology and equipment.

Types of Telemedicine

There are three primary types of telemedicine – Store and Forward, Remote Monitoring and Two-way Real-time Telemedicine.

Store and Forward Telemedicine includes healthcare services for non-emergency situations that can be provided offline, without requiring the presence of the provider and the patient at the same time. It involves the remote patient passing on his medical data like medical history, EMR, scans, reports, past diagnoses etc to the provider who assesses his health status based on the given information and reverts accordingly without carrying out a personal, real-time examination of the patient.

Remote Monitoring includes a telemedical facility actively monitoring patients over remote locations using telemedicine equipment and devices. It is an effective way of monitoring vital signs like ECGs, blood glucose levels, respiratory rates etc for volatile health issues like cardiovascular diseases, asthma and diabetes that require constant care and vigilance.

Two-way Real-time Telemedicine provides consultations, diagnosis and treatment over real-time videoconferencing, live transmission of diagnostic images/videos, phone conversations and other synchronous interactive telemedicine technology where the practitioner and patient remotely connect and interact with each other at a given time with a local doctor as an intermediary.

Besides these, some facilities also provide emergency telemedicine and disaster restoration tele-support services.

Benefits of Telemedicine

Telemedicine services aim to replace or at least equal traditional clinic visits, face-to-face consultations and visiting nurses, save costs and provide better care in locations where the quality of healthcare is not up to the mark. So far, around 50 medical subspecialties have adopted telemedicine with radiology turning out to be a heavy user. Teleradiology is widely used to electronically transmit x-rays, CT scans and other images to remote providers for evaluation and assessment.
Other branches that have resorted to telemedicine to improve their quality, reach and accessibility are dermatology, ophthalmology, psychiatry, cardiology and pathology.

Telemedicine technology allows patients to avail of quality consultations, monitoring, electronic housecalls, testing, diagnosis and treatments from remote locations that may lack the required medical services, connecting patients and practitioners via an integrated, global healthcare system. With telemedicine, practitioners can provide improved diagnoses and better treatments due to comprehensive digital data that is available to them offline and over the web. Follow-ups and monitoring patients becomes easier and more efficient owing to automated active monitoring devices that provide continual and constant connectivity between the two parties. As for patients in remote or under-served areas, telemedicine gives them access to world-class medical services without having to travel or shift base. This not only helps them gain valuable medical advice and treatment from top medical specialists but also saves on their travel expenses, unnecessary hospital visits and in many cases, cost of medicines and expensive health facilities.

Equipment and Facilities Required for Telemedicine

A successful telemedicine program requires specialized telemedicine equipment and facilities. For seamless and uninterrupted delivery of remote medical services, medical devices, peripherals and software solutions supported by expert telemedicine professionals, customer care personnel and training staff must be incorporated within a compatible system that functions according to an effective, tested workflow model.

The following facilities and equipment are usually needed to provide telemedicine services:
- Tele-consultation rooms
- Patient engagement facilities like beds, scopes etc
- Desktops/ Laptops/ Tablet PCs
- Internet Connectivity and Broadband Devices, Routers
- Printer
- Film Scanner
- Digital Camera
- Video Conferencing Kit
- Specialized Tele medicine software for your subspecialty
- Non-invasive pulse and blood pressure unit
- Digital ECG
- Digital Microscope
- Glucometer and Haemogram analyzer
- Mobile vans (in case of mobile or emergency telemedicine centres and ambulatory care sites)

Telemedicine Delivery Channels

Telemedicine services can be provided over four main channels:

1. Point-to-point telemedicine where patients and providers (hospitals, clinics) are connected over private networks directly or through an independent practitioner as an intermediary.
2. Patient is connected to a specialty care provider through tele-videoconferencing for a real time consultation over a home connection.
3. Active tele-monitoring for housebound patients over specialized tele-monitoring systems.
4. Direct web-based telemedicine services and patient-care.

Telemedicine Support in the USA

Despite its numerous benefits, telemedicine has a long way to go before it finds a viable place in the country’s mainstream medical system. The government supports the adoption of telemedicine with a number of incentives and federal grants. The American Telemedicine Association provides more information on federal funding for telemedicine at


Sunday, August 21, 2011

How Can A Smartphone Help You In Your Practice?

75% of American doctors own smartphones and over 95% of them use smartphone healthcare applications in their practice. As a growing number of medical schools and health facilities make it mandatory for students and practitioners to actively use smartphones in their practice, the wireless health market is positioned to grow exponentially in the coming years. Latest smartphone advances in technology and medical applications have provided doctors the opportunity to bring about improvements in almost every function of their practice.

Using Smartphones To Improve Your Practice
Using a smartphone in your practice can help improve its efficiency and productivity in ways more tangible than perceived. These ergonomic, portable devices provide wireless web access and ingenious medical applications that offer limitless possibilities in the hands of a skilled user. For starters, doctors can carry a whole world of medical research, updated real-time information and databases in their pockets, allowing for complete point of care accessibility. 

Apart from providing crucial medical information, smartphones perform a number of administrative and medical functions that can change the way medicine is practiced. On the administrative side, smartphones can be used to maintain calendars, appointments, patients schedules and these can be synchronized with multiple devices like  home and office laptops, tablets and other workstations, making all the information available to you as one simplified, integrated database. Smartphones can work with emails, can be used for emergency notes, memos and patient records, automated appointment and medication reminders, e-prescribing, drug management, billing and policy information and prescription drug references. They are intelligent devices that allow doctors to view and scrutinize medical images, ultrasound scans and ECG reports. Lab orders and results can also be reviewed wherever you are, using your smartphone. 

A growing number of practitioners are connecting with their patients using social media and other interactive web-based apps. These tools typically require a dynamic, on-the-go approach which is possible only via portable devices with inbuilt web access and smartphones fit the bill perfectly. Smartphones are also poised to be smart health monitors that use smart sensors and smart bandages to monitor patients, communicating the relevant data to practitioners through health monitoring apps. Patients and doctors can both receive indicators and warnings on their health dashboards based on the reports of this active monitoring model.
Smartphones can help healthcare professionals manage their day in the field to route patient calls, send instant patient reports and generate bills at the point of care. In fact, telemedicine is now using the NFC or near-field communication technology in smartphones to completely go wireless. This technology uses radio-frequency identification (RFID) that allows patients to pay for healthcare with a swipe of their smartphones.

Mobile Medicine - Smartphone Healthcare Applications
The main advantage that smartphones hold over regular mobile phones is the availability of useful and cutting edge healthcare applications. With over 17,000 medical apps available in the market, we put together a list of apps that are most popular with healthcare professionals of varied interests and specializations. Many of them are free to download (with paid premium versions available) and can be used on the iPhone, Blackberry, Windows, Palm and Android operating systems. Users must check the compatibility of the applications with their smartphone operating systems before downloading.

Platforms Supported
PubMed On Tap

Gives you access to the National Library of Medicine and MEDLINE® citations.
Information on drugs and drug interactions, helps you identify pills using pictures and descriptions, features a well-received medical calculator called MedMath.
iPhone, Android, Blackberry, Palm 
A clinical reference database containing more than 3,200 evidence-based clinical summaries that are updated daily and intended for use primarily at the point-of-care. 
iPhone, Android, Blackberry, Palm, Windows 
A clinical decision support system that includes access to over 8,500 topics in 17 specialties. Combines detailed medical information, expert opinions and recommendations.
iPhone, Blackberry
Skyskape’s RxDrugs
Provides updated dosing guidelines on medications, contains weight-based drug dosing calculators and informative monographs.
iPhone, Android, Blackberry
Taber’s Medical Dictionary
Contains over 60,000 terms, 1,000 photos, and more than 600 Patient Care Statements, in-depth definitions, nutrition and alternative therapy coverage, medical abbreviations, symbols and units of measurement, immunization schedules, nursing diagnoses, links to pronunciations.
iPhone, Blackberry, Android, Windows
Clinical Consult
Diagnosis, treatment, medications, follow-up of most common medical conditions. Drug therapy information, alternative medicines and evidence-based drug information provided.
iPhone, Android, Blackberry, Palm, Windows 
First Consult
Gives you evidence-based answers to clinical questions.
Helps in differential diagnosis with access to over 1,000 diagnoses by organ system, symptom and disease.

Netter’s Anatomy
Provides anatomical illustrations from Netter’s bestselling Atlas of Human Anatomy .
Gives you easy access to complicated medical formulas, scores, scales and classifications.
Information on drugs, interactions, diseases, lab, alternative medicines, toxicology, news and alerts, convenient calculators.
Windows, Palm
Blackberry, iPhone (not on standard download)
Brain Tutor
Contains information on functions and structure of parts of the brain for students and medical professionals. It allows you to explore 3D models of the head and brain in real-time.
Includes drug reference, interaction checker, disease/condition reference and treatment guide, procedures reference, tables and protocols reference, daily medical news and alerts, continuing medical education activities, physician-pharmacy-hospital directories, offline access to clinical reference.
iPhone, Android, Blackberry
Wikipedia Mobile
Helps you view Wikipedia articles on your smartphone.
iPhone, Android, Blackberry, Palm, Windows 

Smartphones mean that you’re carrying large volumes of crucial confidential information in a fragile device. Hence, the FDA has stepped in to regulate the information that you can upload and transmit over certain apps for data security and safety purposes. Hence, users must keep informed about FDA regulations that apply to medical smartphone applications.


Wednesday, August 17, 2011

Why IT Companies Are Important For Doctors?

Healthcare Information Technology (HIT) has the potential to transform global healthcare systems ensuring safer and more effective treatments while increasing the productivity, profitability and efficiency of practices. IT companies have integrated path breaking medical research with ingenious information technology, giving us medical tools, data systems, applications and devices that can change the way healthcare is practiced. Not only has it enabled doctors to connect with patients and other doctors in different parts of the world, HIT makes it possible for them to access a global database of precious medical information. 

Healthcare Information Technology promises to help doctors save money, attend to larger number of patients as well as allow them to implement a patient-centric model of care. The biggest breakthrough that Healthcare IT companies have made so far is the centralization and digitization of patient medical records, popularly known as the Electronic Medical Record or EMR, that has already begun to single handedly revolutionize healthcare as we have known it through the ages.

Benefits of Healthcare IT
The adoption of EMRs, contrary to what is popularly perceived, is as beneficial to doctors if not more, as it is to their patients. Since EMRs allow for the creation of one, single interaccesible national medical data system, medical records can be transferred anywhere in the country to help doctors provide effective, accurate and rapid treatment wherever required. So far, with paper based record systems, quick digital record transfers have been impossible, resulting in many unfortunate treatment errors and failures. 

However, IT companies have made it possible for doctors to improve the quality and safety of healthcare with the introduction of the EMR and other such revolutionizing healthcare tools. This has also significantly reduced the enormous assemblage of paperwork that has characterized physician offices and clinics all these years and has given doctors easier and faster access to information. Health insurance policy records and information are also easily retrievable from medical databases, saving practitioners hours of cumbersome and time consuming search work. 

Adoption of HIT has enabled doctors to optimize the cost of treatment and pass the same onto patients due to higher productivity and efficiency levels achieved in their practice. Features such as Computerized Physician Order Entry or CPOE, bar-code scanners and digital decision management systems increase the accuracy levels of administrative processes and treatments by introducing seamless, methodical practice management techniques. 

IT companies have empowered doctors to improve their practice on several fronts like,
 - Patient safety
 - Improved quality of care
 - Error free, accurate treatments
 - Higher doctor and staff productivity
 - Greater and faster access to patient information and medical research
 - Enhanced revenue
 - Lowered costs
 - Paperless offices and clutterfree working conditions
 - Efficient practice management systems

Doctors and Medical Networking
The Internet and social networking websites have made it possible for doctors to influence a whole medical community and establish themselves as thought leaders in their field. It has also enabled them to interface with a global clientele through video and web consulting tools, online medical diagnosis, web-based symptom analysis, and other mobile platforms that connect them to patients in remote locations. Doctors can join specialized medical social networks where they can exchange and discuss valuable ideas, diagnoses, complex cases and medical information with other dignitaries in their field. Real time industry news is easily available on such sites and is indispensable for keeping physicians updated and abreast with latest information in a field as dynamic as medicine. These forums not only help practitioners gain relevant and required medical information but also get them noticed and respected by peers and patients alike.

Healthcare IT companies are on their way to building a smarter, centralized and digitally managed healthcare system that will link doctors, patients and policy providers through a single, intelligible medical database. This fusion of medical knowledge and information technology driven by IT companies will not only lend patients a more pleasant and personalized healthcare experience, but will enable doctors to work with greater speeds and accuracy. 

However, for real change to come by, doctors must understand the importance of the game changers that healthcare IT companies are, and work in cooperation with them to contribute to a smart, intelligent and seamless global healthcare system.


Tuesday, August 16, 2011

How Much Are The Typical IT Expenses In A Medical Office With EMR?

The introduction of EMR and Meaningful Use incentives has made it necessary for practitioners to undertake effective measures for successful EMR adoption and implementation. In order to maximize returns on EMR and resultant IT investments, physicians must perform a cost-benefit analysis and determine ways in which they can lower costs, save on expenses and utilize IT assets as efficiently as possible. This can be done by charting out a ground plan that underlines all projected expenses and revenue based on realistically researched data and information. 

Budgeting for EMR and IT Expenses
A primary requirement for accurate and realistic budgeting is identifying and understanding various elements that are involved in setting up your EMR and medical IT infrastructure. A good way to do so is by recognizing and incorporating factors that have contributed to successful EMR implementations at other physician practices. An effective EMR and medical IT budget will require you to look at a number of cost factors. Typically, these would include,
 - Hardware, software, networks, servers
 - Internet, wireless
 - Implementation, training
 - Maintenance, Upgrades, Updates, Technical Support
 - Anti-virus and other security systems
 - Emergency breakdowns and recovery
 - Data storage and backup systems
 - Digitization of existing paper files

You will also  need to account for year on year (or month on month) recurring costs and other hidden soft costs like time and money spent on staff training, revenue lost during the adoption process due to readjustment of workflow, resources utilized for internal IT management and so on. Many of these costs are not explicitly spelt out by vendors as they only surface after the installation has been completed. However, they markedly affect your overall profitability and must be carefully accounted and budgeted for.

EMR and Medical IT Infrastructure Costs

The costs of setting up the IT infrastructure for EMR implementations vary from practice to practice and installation to installation. However, to gain a rough idea or a general estimate about how much physicians can expect to spend on some primary variables involved in EMRs and medical IT set ups, we give you a few numbers (naturally, these will vary depending on market and situational factors).

EMR License – Between $1000 - $ 25,000 (depending on whether your system is an entry level EMR or a fully loaded one with advanced features and functionalities)

Hardware – Usually, Tablet PCs are recommended for primary providers and thin clients or workstations are suggested for assistant use. All these are centrally networked via a master server. Tablet PCs may be estimated at $2200, workstations at $1000 each and server at $5000-$10000.  

Implementation Costs – These are usually billed within the range of $90 - $150 per hour. Implementation includes setting up the network, customizing the software to the specifics of your practice as well as staff and employee training. 

In addition, you will need to incorporate projections for broadband connections and other soft costs that are specific to the nature and requirements of your practice.

It is also important to account for returns, benefits and added revenue that will accompany a fully implemented and adopted EMR system. Research by The American Journal of Medicine suggests that physicians can expect to save approximately $29,000 per year starting from their second year of EMR implementation, if the EMR system is used to its maximum potential. 
Another study reveals that EMRs worked to full capacity can increase the number of patients seen by as much as 15%, adding that much more to the physician’s annual revenue.

Optimizing Your Return on EMR Investment

Budgeting can help you draw out a roadmap to minimize unpredictable outflows of cash ensuring a secure financial environment for your practice to function. Even though your budget will focus on minimizing adoption costs and maximizing post-adoption value and returns, in the end, a budget is only as good as the efficiency and method with which it is followed. 

Here are certain guidelines that will help you extract maximum value from your EMR and IT investments.

 - Physicians must look at improving the speed at which the EMR systems are adopted and internalized in the daily workflow of the practice. This will save on a good chunk on staff training and downtime costs.
 - Look at upgrading your existing IT systems wherever possible, instead of replacing them altogether.
 - Try to have your EMR vendor include as much training time as possible, as part of the EMR package.
 - Ask vendors about the payment plans they offer (payment in parts or installments as opposed to complete down payments) and chart out an arrangement that best agrees with your financial interests.
 - Use antivirus software, firewalls and other security systems to prevent unprecedented system breakdowns and crashes.
 - Read all offer documents very carefully and get detailed information and clarifications on terms, products and services mentioned in the contract. Make sure that all verbal agreements are put in writing to avoid post-installation conflicts or confusion.

You can calculate your practice’s return on EMR investment using an ROI calculator similar to the one found at This ROI calculator bases your return estimates on parameters like size of the medical office, number of providers, strength of staff, patient volumes, fees and so on.


Wednesday, August 10, 2011

The Use Of Tablets In the World of EMRs

With a growing number of physicians adopting tablet PCs for their EMR implementations, EMR vendors and IT manufacturers are looking to build compatible native systems to facilitate user-friendly and efficient EMR execution. From table desktops to thin clients and now the tablet, EMRs have been tried and tested on a variety of hardware, each bringing its own benefits and drawbacks. However, the striking surge in EMR adoption on tablet PCs has made providers sit up and take notice of this remarkably promising technology.
Evolution of Tablets in the EMR Space

The tablet technology has found a significant number of users in the healthcare industry. A survey conducted by Manhattan Research reveals that practitioners are leaning largely towards mobile platforms in order to improve the productivity and quality of care, as well as for efficient EMR implementations. According to the research, it is estimated that around 30% of doctors own an iPad, which is the leader in the tablet PC market today. Supported by increased bandwidths and wireless internet speeds, the tablet is expected to become a popular choice among physicians, who are already displaying considerable interest in EMR adoption on tablets. Tracing this dramatic rise in the adoption of tablet PCs in the healthcare industry, IT companies are working on designing specialized platforms that connect smart devices like tablets and smartphones to EMRs. 

Tablets and EMRs  

Even though EMRs on wireless tablets are neatly poised to be the next big thing in the healthcare industry, they do have their detractors. Positively, tablets lend EMRs a host of benefits ranging from portability and enhanced patient communication to increased data accessibility and productivity. Physicians who have worked with EMRs on tablet PCs appreciate their connectivity, usability and design benefits. Tablets are small and light, easy to use and can be conveniently carried for patient visits (as opposed to old-world hospital carts carrying the EMRs on king-sized, unhandy desktops). Physicians can access data from hospital systems and complete their charting in real time while working with patients. Notes can be handwritten using tablets and documents can be wirelessly sent for printing directly from the device. Tablet interface also opens up communication channels between the patients and doctors, contributing to better relationships and improved quality of care. 

While tablet PCs are serving EMR implementations well by helping physicians devise a seamless and efficient flow of healthcare processes, users have nonetheless identified a number of pain points that need to be addressed for the tablet to deliver a dependable and sure-fire system to support EMRs. Firstly, most tablets are not designed specifically for medical use (though this appears to be changing as tablet marketers have identified compelling potential in the healthcare industry). Physicians may not be comfortable using the touchscreen on tablets that do not have a stylus. This makes the data entry process sluggish and eats into the valuable time doctors can spend interacting with patients. Tablets are also tough to clean and sterilize, and touchscreens don’t work with surgical gloves. Since it is a relatively newer technology, hospital IT infrastructure and wireless networking platforms are often not equipped to support and integrate EMR implementations on the tablet. It is easy to lose your wireless signal in old hospital buildings with limited IT support, and a tablet with dropped wireless is as good as of no use considering that most Medical Solutions for the Tablets today are pretty much web based solutions.  

Selecting a Tablet for your EMR

There are a number of factors physicians must consider before investing in a tablet to run their EMR. It is important to ensure that your tablet serves all the primary EMR functions and process requirements. To begin with, your tablet must have a good battery life. It must be easy to operate, user-friendly and durable. Tablets are available in two styles, the slate-style and the convertible-style. The convertible-style has a built-in keyboard and therefore, is heavier as compared to slate-style tablets that do not have a keyboard.  

It is always better to go in for specialized tablets that have been specifically designed for medical and EMR use. iPad and Android are introducing a number of features and apps that support a host of certified EMR systems. Samsung is also making custom Android operating system tablets for EMR and medical use. CNET editors list the highest-rated tablets in the market with Apple iPad 2, Samsung Galaxy Tab , Asus Eee Pad Transformer, BlackBerry PlayBook and T-Mobile G-Slate emerging as top contenders. Other models that have become popular with physicians are Motion LE1600 Tablet PC by Motion Computing and Fujitsu ST5000 Tablet PC by Fujitsu. They are both slate-style tablets and range between $2000-$2500. The Toshiba Portege, Acer C200 and IMB Thinkpad are also good convertible-style options.



Sunday, August 7, 2011

What Type Of Support Do You Need When You Go On An EMR?

A number of EMRs in the market today are loaded with stunning features equipped to help physicians meet their Meaningful Use objectives. However, it is not possible to utilize these features to their maximum potential without adequate EMR support and training that must be provided by your EMR vendor.

EMR Installation Support

To begin with, your EMR provider must undertake the entire installation of your EMR system. In case of a client-server system, a qualified and trained installation team must be sent onsite to set up the software and assist you in going live. The team must ensure that your system is configured to meet the requirements of your practice. It must seamlessly and diligently integrate the EMR in the existing work system without leaving any loose ends or installation glitches that may later bring the practice to a grinding halt until help arrives.

EMR Training Programs

Making the shift to an EMR based practice will require your EMR provider to walk with you every step of the way until and even after you are thoroughly and completely settled in. A good EMR company will offer training programs for users at all levels of the practice to help you and your team effectively accommodate the new technology in your daily work lives.

Onsite and web-based training is important to equip your staff with the necessary skills required to use the EMR in a way that contributes to the practice’s productivity and Meaningful Use objectives. EMR vendors must offer training programs conducted by certified and trained EMR experts. Learning centres, live online and telephonic EMR guidance, and other platforms for EMR assistance must be provided. 

Local and Onsite Technical Support 

Technical EMR support services must be available locally and onsite. Qualified and trained technicians must be assigned and duly deployed to help you with any situation that may arise pertaining to the working of the software, upgrades, customization or any other assistance required.  A single local point of contact must be provided, ideally free of cost, to help you with the required technical support with minimum response time or disruption of practice schedules.
Web-Based Online Support
Most web-based EMR systems offer online technical support and assistance. Client-server EMRs also supplement their onsite support services with online support as a faster and more convenient means of problem resolution and assistance. Additionally, web-based EMR systems provide online training, support services, regular and automatic software updates, usually at no extra cost.
Hardware Support

Your EMR vendor must provide hardware support and technical infrastructure analysis to help you set up your EMR software on a compatible hardware system. You can seek their assistance on computer specifications, internet or broadband options, devices like signature pads, mobile tablet PCs, printers and scanners that help you maximize the efficiency and productivity of the EMR software.
Complaint Management and Grievances
You must ensure that your EMR vendor has an efficient and responsive customer support and complaint management platform. Grievances must be addressed in the least possible response time with certified help available locally as well as online. The EMR provider must be expected to fix the problem efficiently, without interrupting the work flow and routine of the practice.

While most EMRs sell on features, they lose out on their customer support. It is easy to give in to the incredibly assuring presentations made by EMR vendors, but to ensure the long-term feasibility of an EMR implementation, you will have to look beyond this marketing veil and probe deeper into the EMR company’s service, support and training standards.