21 st Century Transformation of Medical Office IT Systems “Paperless Offices, Shared Databases, and Secure Collaboration” Robert L. Smith, MD, MS March 5, 2009, Syracuse, NY

“Electronic Medical Records DO NOT REPLACE Old Systems of Inefficient Workflow”

Cost of Old Workflow Annual Dictation Costs: ~ $18,000 Annual Rent for chart room space: ~ $3,000 Salary/Benefits for FTE Receptionist: ~ $27,500 Answering Service: ~ $1,000 Total Cost Annually: ~ $50,000 WORTHLESS! Inefficient Workflow... WORTHLESS!

Cost of New Workflow Amazing Charts, ~ $1195, 2 MD, one time cost! Support and Off-site Backup, $500 annually Virtual Office, ~ $12/monthly for up to 10 users Onebox.com, ~ $125 monthly for phone/fax/ LogMeIn, ~ $30 annually PRICELESS! Annual Cost, ~ $2, PRICELESS!

Family Medicine Office Case Study Electronic Medical Record System Integrated Communications Medical Survey Tools Virtual Office and User-Definable Databases Community Collaboration Network Remote Access Telemedicine Live Internet Support Website Integration of Communication Streams

Telephone System Online Collaboration Virtual Office EMR and Fax Live Support Remote Access

Electronic Medical Records Amazing Charts, $995 for first provider, $200 each additional provider. No cost for staff! Pros: Affordable for immediate implementation, free 90 day trial, ease of use, recent SQL server upgrade. Cons: No CCHIT certification yet. A tool, not the entire office solution! “EMRs should not dictate or constrain how your workflow is organized or completed. It is merely another tool in our doctor’s bag to organize, synthesize, distribute, and manage information”.

Integrated Communications account and a toll free phone/fax number incorporated into a single account. Onebox GotVmail eFax RingCentral

Onebox Example Automated Answering Service Voic Box Fax Server (inbound and outbound) Server (inbound and outbound) Find Me/Follow Me Functionality Remote Programmability Click to Call Functionality

MIaDoc Example Desktop Application for receiving faxes, s, and voic s. Document manager for signing off documents and routing them to others or into an EMR. Amazing Charts Integration. Ability to receive information from the outside world in a digital format and push it into a patient’s record or fax/ to patients and colleagues.

Class Apps Application. Secure, customizable forms for collecting data. Examples include new patient registrations, visit requests, refill requests, diabetic sugar logs, depression screening questionnaires, etc. Searchable data fields for data analysis. Originally designed for customer service and marketing, applied to healthcare. Easily integrates into websites and templates. SSL encrypted for HIPPA compliance. Medical Survey Tools

“Virtual” or “Web” Offices Webexone’s “Weboffice” or “Intranets.com” Shared Calendars, Task Management, Document Management and Databases Database tools Office Based Coumadin Clinic Hospital Based Stroke Program Chronic Disease Registries Newborn and OB Tracking Registries Patient Portal application Webfolders to drag-and-drop into virtual office Community, Practice, Personal Weboffices Other examples include Hyperoffice and Central Desktop

Anticoagulation Clinic Office Based Anticoagulation Clinic Automated views for physician and nursing staff Tickler file view with alerts of when INRs are due Database format can be easily transformed into a flowsheet for integration into the patient’s chart. Patient access is possible through a secure portal. Colleague access is preferred for a multidisciplinary and medical home care team.

Stroke Center Database Hospital Based Stroke Program at Holy Cross Hospital, Bethesda, MD. Weboffice used as the backbone for a multi-specialty care program encompassing Emergency Medicine, Neurology, Neurosurgery, and Hospitalist services. Hospital-wide Cerner system could not handle the specific workflow that physicians and nurses need to get their work done effectively. Real-time data points during the patient’s hospitalization for quality measures. NIH pilot project followed real-time data of inpatient stroke patients instead of chart reviews after the patient’s discharge.

Question 1: Who Is On Call For This CVA Patient?

Question 2: Where Are My Patients & What Is Their Status?

Question 3: Can We Track Core Measures Directly Out Of Our Clinical Workflow?

Customized views of data that has been easily entered near the point of care, with exported reports of core outcomes measures

Importable and Exportable time tracking view of key process events for quality measures

Chronic Disease Registries Chronic Disease Management of Diabetes, CAD, COPD, etc. Guidelines and protocols can be tracked and monitored through disease specific databases and views. Specific views can easily be created to alert for outliers and patients with poor disease management control. Easily interfaces with an EMR through an XML or XLS export. Newborn tracking, OB prenatal tracking, pediatric signout, inpatient signout, cal schedule management, etc. The possibilities are endless and are generic and separate from expensive, hospital based systems.

Virtual Office Types Personal Weboffice Professional Weboffice Community Weboffice

Remote Access LogMeIn GoToMyPC pcAnywhere Citrix Windows Remote VPN

Your Website as a Communications Hub Website as a FTE Receptionist Posting of general information and links for your patients Downloadable forms and authorizations Refill and visit requests Patient Portal access Central communications site for online meetings, secure chat, and s.

Provide Support Example Provide Support allows for visitors to your website to securely chat with your staff or with clinicians as virtual visits. Messages are left when “operators” are not signed in SSL option Ability to push messages out to website visitors Transcript of Chat Session ed to you for inclusion into the patient’s medical record.

Telemedicine Skype Google Talk AIM GoToMeeting Webex Meeting Citrix Human Network

UpDox Network Example Secure Messaging and Task Management Collaborative Environment File Sharing Instant Messaging Group Inboxes Automated Workflows and Rules Engine Screenshot Utility Outbound s and faxes EMR Integration

Replace Old-Fashioned, Linear, Non-Searchable Workflow With a …

Telephone vs VOIP Online Collaboration Virtual Office EMR and Fax Live Support Remote Access Digital, Searchable, and Collaborative Network

Appendix A