Monday, March 17, 2008

Is Wal-Mart off the Wall(-Mart)? Thoughts on EMR Cost

Wal-Mart, beloved and reviled omnivendor, plans to sell "affordable" EMR software to smaller practices that are loath to invest in "higher costing" systems. Hardware, software, installation, maintenance and product training will be available through Sam's Club for a price that, apparently, undercuts competition by 50%.

Well, I don't know whether I should clap my hands together like a jolly newborn or claw at my own skin while listening to this song.

Because, on the one hand: Nothing could be a clearer harbinger of widespread EMR use and adoption than to see Wal-Mart jump on the proverbial EMR-bandwagon. And that's nice.

But, on the other hand: What?!?!?!

If practices reluctant to adopt EMR are willing to invest in systems simply because they're cheap, we suspect these practices are laboring under some major misconceptions about the value and function of EMR.

Thus, we would like to offer our two cents regarding EMR cost versus EMR value. (Since our specialty is ophthalmology, we will speak about our experiences in that particular field -- though we believe you can apply our points more broadly to other specialties.)

When considering the switch to EMR, a practice should calculate the value of the EMR system. We believe value can be assessed by the following three questions:

1. Will the EMR compromise workflow and slow me down? If an EMR slows you down in the exam room, you can't afford it - no matter what it costs. Unfortunately, many EMRs, particularly general purpose EMRs, do just this, and claim it to be a necessary drawback of all EMRs. This is not the case! Specialty-specific EMRs, like IO Practiceware, are generally better at addressing the needs of each practice - and so can actually enhance and improve workflow. We can't speak for all specialty-specific EMRs, but we know, for a fact, that ours is fast.

2. How much time will my staff and I have to spend customizing the software? Most vendors require that you create or modify templates. They claim that these templates are an important part of customizing process. We believe, however, that asking doctors to create templates for their most common findings is simply an admission that the EMR company (because it wasn't designed exclusively for a specialty, like ophthalmology) doesn't understand enough about that specialty to create software that allows physicians to enter their findings. While templates might seem like a plus, they actually ask you to make decisions about EMR that you are unequipped to make - not because you don't know your field, but because you are unequipped to design software. No offense, or anything. But, yeah -- I can't run a 3 minute mile, and you can't design software! Deal with your limitations!

3. How much help will I get transitioning over to EMR? Implementing an EMR is a big change for your practice. We have learned from experience that you can use some help during the first weeks after installation - particularly with respect to solving the inevitable workflow problems that arise as you move to any new system. If your EMR package doesn't come with this kind of customer service and attention, then it is likely you have invested in a product you won't be able to use properly.

Now that we've laid it down, it's time for us to toot our own horn: We believe that IO creates more value than its competitors because it's much faster in the exam room, it can be easily integrated and customized to suit your ophthalmology practice's workflow, and its package comes with training and support that ensures success.

We know that many of you fret about EMR cost. Many vendors, like Wal-Mart, charge “a la carte” – a certain number per physician, per office, for data conversion, equipment interfaces, training, on-site support, and other add-ons. But IO prefers inclusive pricing – including in the initial estimate all the things a particular practice will need. (For more info on our pricing, click here.) And while different vendors use different formulae to calculate price, the truth is: all the serious EMR players in ophthalmology end up with about the same result. And if not, well... just ask yourself the three aforementioned questions and determine the true value of your (ostensibly) "cheap" purchase.

IO Practiceware offers you a complete system. We sometimes joke that our competitors sell an EMR "kit." But we deliver a finished product - without sacrificing any potential for customization.

IO Practiceware is revenue positive from the start -- with no sunk costs, not even in the first year. This should be a major consideration in your quest to find an EMR that's right for you.

Questions? Comments? Leave us a note below or send us an email.

(Cited: FierceHealth IT's article on Wal-Mart's EMR Marketing.)

Wednesday, March 5, 2008

IO Practiceware: Frequently Asked Questions

Everything You Always Wanted to Know About IO Practiceware*
*But Were Afraid to Ask

Or, Frequently Asked Questions

Q: Is IO Practiceware an internet-based system or does it utilize a server on the practice site?

Q: Your big-button touch screen design is fast, but does it limit functionality?

Q: Why are there no dropdowns?

Q: Why doesn't IO use templates like other EMRs?

Q: In the event of an extremely anomalous patient or finding, does the doctor have the option of typing in notes?

Q: Will IO Practiceware let me e-prescribe and collect Medicare's incentive in the coming year?

Q: Does IO Practiceware supply its own practice management system?

Q: Should I buy IO Practiceware's practice management system or interface with my existing PMS?

Q: Does IO Practiceware use an external system to manage its images, or is this included in the system?

Q: Are there additional fees for updates, upgrades, customer service, hardware and network, or is this included in the pricing?

Q: I would like to get a price quote from IO Practiceware - what information should I send to you about my practice?

Q: If a doctor wants to order a medical work-up, how does he/she print out the specific tests to avoid actually writing it out by hand?

Q: Do you have a sample CD of your software that I can play around with before I purchase your product?

Q:
Why do you need to "supervise" my playing with your software?

Q: How much does IO Practiceware cost?

Q: How do I submit an FAQ?


Q: Is IO Practiceware an internet-based system or does it utilize a server on the practice site?

A: IO's software can run with or without a local server. In offices where patients are seen more than one day a week, IO recommends the use of a local server in order to achieve the maximum speed possible - particularly in the exam room - because using a local server optimizes some of our software's features (i.e. scanning, image management and interfacing with test equipment). If a practice prefers remote connection via the internet to either a server hosted at the main practice office or at IO's office, we recommend this only for locations where patients are seen less than one day a week or where patient volume is very light. Back to FAQs

Q: Your big-button touch screen design is fast, but does it limit functionality?

A: The IO screens are designed to present you with the all information you need to perform the task at hand. Each screen presents only the portion of the patient's record that is required for analysis and a method for entering your findings, impressions or billing information. IO believes that displaying all information on a single screen slows you down because it's harder to see the information you're looking for. Back to FAQs

Q: Why are there no dropdowns?

There are no dropdown menus because they slow doctors down. Our big-button design offers the fastest possible interface -- a tried and true method of fast data input. (Ever been to a fast food restaurant? Orders are entered via touch screen.)

Perhaps it's helpful to think of IO's touch screen as a series of rooms, and each button as a doorway. When a doctor sees a new patient, he or she walks through a series of doorways, systematically and consistently arranged, and "maps" the patient's specific diagnoses and treatment plans. Each room has a theme or principle of arrangement that can be customized by the doctor, depending on what he or she frequently records, prescribes, or notes (see next question).

If it's hard to conceptualize through our description how exactly IO Practiceware's software works, we strongly encourage you schedule an online demo. It's the best way to understand firsthand just how fast IO's data entry is. Back to FAQs

Q: Why doesn't IO use templates like other EMRs?

A: Asking doctors to create templates for their most common findings is an admission that the EMR company (because it wasn't designed exclusively for ophthalmology) doesn't understand enough about the specialty to create software that allows physicians to enter their findings. IO presents findings to doctors that are related to ophthalmic conditions and easily facilitates entry via a graphical interface (i.e. just touch the finding and touch the corresponding part of the eye). Of course, if the physician is interested in customizing IO's software to suit his or her needs, it is possible to adjust many of the IO screens and fine tune them to individual doctor's clinical and linguistic preferences. The key difference is: we don't ask you to perform the impossible task of inventing your own software, because, inevitably, you'll spend more time later trying to fix it. Back to FAQs

Q: In the event of an extremely anomalous patient or finding, does the doctor have the option of typing in notes?

A: Yes. All systems come with a keyboard and mouse. While our touch screen design discourages the use of typing (because typing is much slower), doctors may use the keyboard (or dictate) if the need arises -- but it's IO's job to make sure that rarely happens. And, believe us, our buttons cover pretty much everything -- including Marcus Gunn jaw-winking...and its reverse! Back to FAQs

Q: Will IO Practiceware let me e-prescribe and collect Medicare's incentive in the coming year?

A: Yes. We are currently in the process of becoming fully certified with our partner, SureScripts-RxHub, at which point we will offer the service of e-prescribing to all practices that use IO's EMR system. Back to FAQs

Q: Does IO Practiceware supply its own practice management system?

A: Yes. IO Practiceware's software includes its own practice management system. We can, however, (in most cases) interface with your practice's existing PMS (see next question). Click here for more information on IO Practiceware's integrated PMS. Back to FAQs

Q: Should I buy IO Practiceware's practice management system or interface with my existing PMS?

IO's system can interface with your existing PMS if the software is capable of interfacing with an HL-7 system -- which is, in short, a software standard by which transactions and information exchanges can exist between pieces of software (i.e. name, phone, address, etc.). We have found, however, that operating with two separate systems leads to more costs than benefits, primarily because after you install our EMR system you will have to pay two monthly fees (one to IO Practiceware for upkeep, service, and continuing development, and one to your PMS provider). In the end, however, it is entirely up to your practice to decide the best way to proceed. Back to FAQs

Q: Does IO Practiceware use an external system to manage its images, or is this included in the system?

A: IO Practiceware's software includes its own system of image management that is fully integrated with your practice's test equipment. We can, however, interface with your practice's existing image management software if this is a preferable. Click here for more information on IO Practiceware's image management system. Back to FAQs

Q: Are there additional fees for updates, upgrades, customer service, hardware and network?

A: No. Your monthly fee includes all enhancements and upgrades. Back to FAQs

Q: I would like to get a price quote from IO Practiceware - what information should I send to you about my practice?

A: To estimate the cost of installing our IO software in your practice, we need to know the following:
  • Approximate number of patient encounters in an average week
  • Number of full time / full time equivalent doctors your practice has (MDs, DOs, and ODs)
  • Number of practice locations
  • Do you dispense glasses? If so, at how many locations?
Email us for a customized estimate. Back to FAQs

Q: If a doctor wants to order a medical work-up, how does he/she print out the specific tests to avoid writing it by hand?

A: Our software allows you to print a test order with a single click. Simultaneously, the software notes the command on the patient's chart and posts a note in the "alert" section of our "highlights" screen. This means that our disposition sequence ensures 1) that the patient's work-up is accurate, 2) that the patient's chart records the request for this work-up, 3) that some sort of follow-up will occur, whether that's a notification to say the test has been done or to remind the doctor/practice that the test is still outstanding. Through easy notation in an area called "clinical follow-up" the chart maps the test results and monitors non-compliance. Back to FAQs

Q: Do you have a sample CD of your software that I can play around with before I purchase your product?

A: IO welcomes you to use our software yourself, but, rather than hand you our EMR on a CD, we ask you to engage in what we call "supervised play." Supervised play means you set the pace and the exploratory path, but we get to tag along and help you if you get stuck. Supervised play is done remotely from the comfort of your home or office and an IO Practiceware staff member watches and concurrently answers your questions over the phone. Back to FAQs

Q: Why do you need to "supervise" my playing with your software?

A: Imagine you'd like to do something else unfamiliar -- like, fly a fighter Jet or bake an apple soufflé -- would you go at it alone, or would you seek the guidance of someone who knew the ropes? Without them, how would you know which buttons to push? How much powdered sugar to sprinkle? Of course, our EMR is much easier to master than fighter jets or soufflés, but the point is: during supervised play, our goal is to act as a resource for you as you experience our software for the first time. You would do a disservice to yourself if you randomly clicked around screens that had no meaning to you and led you to decide, because of misinformation, that IO Practiceware's EMR was simply a pain in the neck. So give supervised play a shot; you'll be glad you did. Back to FAQs

Q: How much does IO Practiceware cost?

A: There is great diversity among ophthalmology practices that use our software, so it's impossible for us to publish a cost estimate that accurately applies to every practice in the community. We are happy, however, to give you a customized estimate based on these criteria. Back to FAQs

Q: How do I submit an FAQ?

A: Post your question in the "Comments" section below, or request a call back from our IO Team. Back to FAQs