Thursday, December 23, 2010

Getting Indoor Papers after Patient’s Discharge

When discharged from the hospital after being treated successfully, the patient and relatives feel relieved that they may not have to come back. However, they soon realize that they will have to return (may be a few times) to the hospital just to get the requisite indoor papers to file their claim for health insurance.

This process of getting these indoor papers often becomes cumbersome and more so frustrating. Because it’s an interaction between 3 parties – the TPA, you and the hospital – it’s very easy to forget obtaining / sending an important record simply due to communication gaps.

Post-treatment care of the patient is really important; time and effort of the relative should be focused on patient support and care rather running around for papers. 

Wouldn’t it be great if we could get all the hospitalization records at home? – For starters it saves the travel trouble. It will be even better if you also get softcopies of the records – so that you can share them easily with the TPA and also keep them as record – becomes a part of patient’s medical history – especially helpful if he / she may have to be treated for some ailment in the future.

Wednesday, December 1, 2010

Use the internet for Doctor’s Opinion

Diagnosis of ailments as well as patient care in some parts of the world – West Africa, Central Asia, Middle East are still suboptimal.  Based on the good reputation of Indian doctors, various entities in India, including the Government are pushing the case for Medical Tourism.

Although the healthcare in India is far cheaper than any of the Western Countries; in absolute terms it can still cost a lot. Here comes in a scope for medium which empowers the patient overseas to gauge the need to come to India.

Consider this – I live in Addis Ababa, Ethiopia. I am a patient suffering from an advanced disorder and am consulting a specialist doctor from Mumbai. Won’t it be great if I can share my latest reports (done in my home town) with the doctor easily through the internet. This will not only keep the doctor up-to-date with my latest medical findings, but also enable him to promptly advise me whether I need to travel to Mumbai.

Sharing of records can be done via email. However, this may make it difficult for the doctor to compare the latest findings with the previous ones. So you need one place where you can store all your records, in the way the doctor wants to view it – so he / she can easily compare you current results with historical ones – this makes a case for web based EHR.

This may be applicable in B and C-tier towns in India as well – when a patient needs to looks for a doctor in a metro for an opinion.

Monday, November 8, 2010

EMR Standards

The Ministry of Health and Family Welfare, Government of India, has recently constituted an Expert Committee for setting the Indian Standards for Electronic Medical Records.
The First Meeting was held in New Delhi on September 30, 2010.
Following some introductory discussions, three sub-committees have been formed for: (i) Standards (ii) Data Connectivity and (iii) Data Ownership. The respective sub-committee members are interacting among themselves during the intervening periods too.
The second meeting will be presided over by the Secretary of Health and Family Welfare, Government of India.
Hopefully by the end of its tenure there would be set guidelines for practicing e-health in India.

Tuesday, October 26, 2010

When you are on the move -

I travelled to Delhi last week. Before I took my flight, I was already feeling early symptoms of fever, but wrote it off as common cold.

However, the day after I reached Delhi, I was down with temperature. The following day, I visited a Doctor. Being, my first visit, he took 15-20 mins just to understand my history, my allergies, and more since sinusitis has been troubling me since a while.

Considering the prevalence of malaria and dengue nowadays, the doctor asked me to do a CBC and some other tests. I had got these tests done just 2 days before for my insurance - Obviously, I had not expected the illness and hence was not carrying my reports. I didn't even recall the results. So another round of tests was unavoidable.

One may concur, if you have fever, even if you sitting for as little a 15-20 mins,,, you body starts paining. I was at the clinic for around an hour, first the waiting , and then the consulting.

Fortunately, my tests were negative (the results only came out in the evening, so I had to visit the doctor a second time), and doctor suggested it was just a viral.

The point here is - a lot of time got consumed here just to get to the diagnosis, which would reduce substantially if I would be carrying my medical history and my reports. Obviously it’s not practical to carry your medical file everywhere you travel, but certainly if it is available on a chip, or a cd or even on web - it should be greatly helpful.

Friday, October 8, 2010

Paper Records outsourcing a solution to end the woes?

Paper records are generated by all businesses. Be it the part of the processes, like forms for telecom companies, banks, financial institutions, etc or the mandatory papers such as financial, tax papers, vouchers, ledgers etc., and papers just keep on piling, I just don’t want to be in a situation where I have to fear the loss of my important documents.

Only if I had an alternative arrangement, I would have freed up my costly real estate space and utilised for more meaningful purpose rather than using it for dead storage.

What a mess these papers create, once the record keeping goes even a little out of sync.

Oh I literally waste my personnel in just maintain my records!!!

These questions must be bugging many a businesses, especially where the real estate and man-power cost are spiralling up.

Wouldn’t it be fantastic if we had an option of outsourcing these non-core works?

Physical Storage of documents at distant place by a specialised firm is just the right answer.

Just imagine for an educational institute, it may free up space for additional classrooms or labs, for a hospital it might free up space for additional beds, or equipments.

If I need to summarize the need for Physical Storage of Documents at Distant Place, I would put it as

  1. Tedious process of management, storage and retrieval of the paper-based documents
  2. File and document storage issues and related cost of realty
  3. Paper Document handling issues
  4. Paper transportation costs while routing/ sending/ distributing the documents to various personnel across the group
  5. Rising Printing, Faxing, Photocopying, mailing and courier (distribution) costs
  6. Tedious Audit Process and rising audit cost
  7. Tedious process in linking of the various documents
  8. Tedious process of tracking files and documents and related comments/ annotations

And what benefits do I derive from it? Well to put it in simple words would be.

  1. Savings in realty cost for Storage of documents
  2. Minimized turn-around time for key organizational processes
  3. Organized Documentation and hence faster document search resulting in savings in time and increase in productivity
  4. Safety against Natural disasters and loss of Paper documents
  5. Sharing of Documents online, thereby reducing the distribution costs.
  6. Savings in Manpower cost for manpower related to storage and management of documents
  7. Facilitates security and integrity of documents, hence minimizing chances of fraud and illegal activities.
  8. Overall improvement in Enterprise productivity and management of corporate knowledge

Monday, September 27, 2010

Managing health during pregnancy...

My wife has just entered her 7th month of pregnancy. It ‘s a given that, the nine months of your pregnancy our crucial. There’s too much at stake to slip up...

Everything spanning from eating habits, exercise routine, medication to weight needs to be taken care of.

Understanding that in our busy lives today, ‘taking care of ourselves’ is also viewed as an overhead – Keeping a track of doctor’s prescriptions, visit dates, ultrasound reports and locating them when you need the most may become stressful.

There should be a simple way in which a person can store all her reports, prescriptions, notes, etc at one place – systematically – so that whenever she requires the desired information, she can easily access it.

You can use an EHR to do all of this. Simply collate all your vital information and put in one EHR. So the next time you want to compare ultrasounds from your first and six months, or recollect the name of your 3rd month medication by seeing the prescription,, and so on,,, it will take just a couple of minutes.

Saturday, March 27, 2010

How prescriptions are written matter to you

In India, it is common for doctors to write prescriptions for drugs based on the brand name and not the generic drug name. So a doctor will write a prescription for Metacin, Crocin etc. and not Paracetemol, Aspirin etc.

To understand why this is important for your health read on….

On the way back from work the other day I decided to stop over at a friend's place in Goregaon. She told me that she was sick and the doctor had prescribed the "Hilfas Kit" for her. She asked me if I could pick it up from a chemist near Goregaon station on my way to her home. I visited about 10 chemists and no one had even heard of the "Hilfas Kit" (I don't know why there need to be 10 different chemists near the station and that too only on the East side, but I’ll address the reasons in another blog).

I found it strange that none of the 10 chemists had even heard of the Hilfas Kit. So I asked my friend if she had her old medicines and if she could send me the drug names and their dosage. Luckily, she did. The Hilfas Kit, it turns out, consists of 2 fluconazole tablets 150mg, 1 azithromycin tablet 1g and 1 secnidazole tablet 1g. I asked a few of the chemists if they had the a similar "combo kit". They all did but yet they had not heard of Hilfas. That's because Hilfas is the name of one of over 10 companies that manufacturers the exact same kit.

Here’s the problem: suppose you have been taking the Hilfas Kit for a while now and the underlying problem is not going away, you decide to consult another doctor or a specialist. You show your prescription to the doctor and she doesn’t know what the Hilfas Kit is. How can she make the right diagnosis? How about if you wanted to get a second opinion from a doctor in another country say the USA? How will the doctor figure out what drugs you have been taking?

One way to fix this problem is for you to add the prescription to your Electronic Health Record (EHR). When you do that you will realize that the Hilfas Kit does not exist and you can call your doctor to understand what the underlying drug is. Of course, the best way would be if all doctors just entered the generic drug name and not the brand name. As EHRs gain more acceptance and are used more frequently this will become the norm.

Friday, March 19, 2010

Healthcare Initiatives Underway in the US

The American Recovery and Redistribution Act of 2009 (ARRA) allocated $19 billion towards health information (HIT)*. The $19 billion will be allocated as incentives to medical providers who implement EMR systems as well as to states to create Health Information Exchanges (HIEs).

For physicians, the full payment between 2011 and 2015 will range between $44K and $60K. For each year a physician is not in the program, the incentive payments decline by 1% each year. The ultimate calculation of payments to physicians is based on Medicare patient volume.

For hospitals, the incentive payment begins at $2 million in 2011, with additional payments based on Medicare volumes. As with physicians, the incentive stops in 2015. In 2015, there will be penalties for providers not participating in the program.

ARRA, thus is not only an economic stimulus bill, it's an HIT stimulus bill for adoption by providers.

2011 (Stage 1 of Meaningful Use)

By 2011 all medical providers need to have a certified EMR system. The Certification Commission for Health Information Technology (CCHIT, does the certification of EMR systems.

There are currently 12 doctors in the US Congress. All have indicated that the 2011 deadline is “too aggressive” so most likely the date will be extended.

2013 (Stage 2 of Meaningful Use)

All medical providers must provide each patient access to all of his/her information via a patient portal. For example, if a patient has taken a drug test the patient must be provided access to find out whether the doctor has seen the test results as yet or not. The patient should also obviously be able to see his/her test results. This has implications for Medicare/Medicaid. Doctors could be flagged if their patients have not taken particular tests. Meaningful Use also entails requiring medical providers to share information with each other.

Currently, only about 10 EMR solution providers truly have the capability of providing a patient portal. For most of the others either the EMR solution is only client/server based or they are trying to develop their solutions for certification. Microsoft is a good example with its solution being under development.

Solution providers will also need to be in a position to show “compliance”. Example, % of patients who have taken the annual exam.

2015 (Stage 3 of Meaningful Use)

By 2015 all states must have in place a Health Information Exchange (HIE). The government provides incentives to states for setting up the HIE. In addition, states can make money through advertising etc.

All medical information for a patient must be uploaded to the state HIE by all medical providers. This will ensure that a patient’s information will travel from provider to provider. This has several advantages including: eliminating the need to complete new patient documentation each time the patient sees a new medical provider, allowing a patient’s medical reports to be carried with him, thus reducing the number of “duplicate” tests the patient has to take.

Medicity is a good company providing this service.

* ARRA provisions for Health Information Technology (HIT)

Provides approximately $19 billion for Medicare and Medicaid Health IT incentives over five years.

· Officially establishes the Office of the National Coordinator for Health Information Technology (ONCHIT) within HHS to promote the development of a nationwide interoperable Health IT infrastructure; President Bush already created ONCHIT by Executive Order in 2004.

· Establishes Health IT Policy and Standards Committees that are comprised of public and private stakeholders (e.g., physicians) to provide recommendations on the Health IT policy framework, standards, implementation specifications, and certification criteria for electronic exchange and use of health information.

· HHS would adopt through the rule-making process an initial set of standards, implementation specifications, and certification criteria by December 31, 2009.

· ONCHIT would be authorized to make available a Health IT system to providers for a nominal fee.

· Provides financial incentives through the Medicare program to encourage physicians and hospitals to adopt and use certified electronic health records (EHR) in a meaningful way (as defined by the Secretary and may include reporting quality measures). Authorizes ONCHIT to provide competitive grants to states for loans to providers.

· Medicare incentive payments would be based on an amount equal to 75% of the Secretary’s estimate of allowable charges, up to $15,000 for the first payment year. Incentive payments would be reduced in subsequent years: $12,000, $8,000, $4,000, and $2000, after 2015. Physicians who report using an EHR that is also capable of e-prescribing would be eligible for EHR incentives only.

· Early adopters, whose first payment year is 2011 or 2012, would be eligible for an initial incentive payment up to $18,000. In 2014, the payment limit would equal $12,000. Adopters, whose first payment year is 2015, would receive $0 payment for 2015 and any subsequent year.

· For eligible professionals in a rural health professional shortage area, the incentive payment amounts would be increased by 10 percent.

· Incentives under the Medicaid program are also available for physicians, hospitals, federally-qualified health centers, rural health clinics, and other providers; however, physicians cannot take advantage of the incentive payment programs under both the Medicare and Medicaid programs. Eligible pediatricians (non-hospital based), with at least 20 percent Medicaid patient volume, could receive up to $42,500, and other physicians (non-hospital based), with at least 30 percent Medicaid patient volume, could receive up to $63,750, over a six-year period.

· Physicians who do not adopt/use a certified Health IT system would face reduction in their Medicare fee schedule of -1% in 2015, -2% in 2016, and -3% in 2017 and beyond. E-prescribing penalties would sunset after 2014.

· Allows HHS to increase penalties beginning in 2019, but penalties cannot exceed -5%. Exceptions would be made on a case-by-case basis for significant hardships (e.g., rural areas without sufficient Internet access).