e-Prescribing

Lately, we have put a lot of blogs up about smart phones and how they integrate into the medical community. One of the most important ways that they can make health-care provider’s lives much easier is through E-prescribing. A lot of doctors and health agencies have already implemented some form of sending prescriptions via an electronic service, citing the ease of use and timesaving aspects that electronic prescriptions offer. However, that isn’t all that E-prescription can do for you; it can also save you money.

New governmental initiatives are pushing for modernization of data maintenance across the board in the medical services, including prescriptions. In order to accomplish this, the federal government passed the HITECH Act in 2009. This act offers incentive payments to physicians through Medicare and Medicaid if they use electronic prescriptions for more than 40% of their prescriptions, not including those for controlled substances.

Government incentives are direct ways in which E-prescribing can cut costs. There are, however, many indirect ways that handling your prescriptions electronically can reduce your overhead. The most important of these is in the time saved. “time is money” is a cliché for a reason. Although it may seem quicker to just write out a prescription by hand, this is not the case. In fact, one third of all hand-written prescriptions necessitate a phone call from the pharmacy for clarification. To put this in more stark relief, the Medical Group Management Association estimates that, on average, medical practices receive fifty phone calls a day from pharmacies. These calls are disruptive to workflow, and thus consume time.

Furthermore, E-prescribing makes more efficient use of the physician’s time. Electronic prescription systems contain databases and programs that account for drug interactions and contra-indications, which means that the physician does not have to. Over time, this increases efficiency and productivity, and both add up to dollars saved. In one study, published in 2007, a group practice of thirteen physicians claimed that by transferring their records completely to an electronic format, they saved 1 million dollars in the first year and a half. Considering that this included the cost of implementing the system, that is an impressive saving (especially when you take into account that this does not include the federal reimbursement mentioned above).

For more on E-prescription, read Electronic Prescribing: Building, Deploying and Using E-prescribing to Save Lives and Save Moneyput out by the Center for Health Transformation. For more information on the HITECH Act, see Electronic Prescription Is Safe And Efficient, However Hurdles Remain.

eye exam via smart phone

Dexcomm has been in the communications industry since the 1950’s and over that time we have always strived to stay on top of the amazing changes in communications technology.  We were the first telephone answering service in the state to be able to receive and deliver emails.  We offer sms, email, and fax delivery, web based on call management,  and are currently bringing onboard a completely secure and HIPAA compliant smart phone app that will allow medical practices to communicate all their messages in a private and encrypted environment.

Our secure messaging app for smart phones is an one example of great leaps in technology.  Another example aimed at helping people around the world is featured in the following video.  Netra has developed an app, and cheap ($2) accessory to the smart phone that can provide quick and accurate eye exams.  The impact that this development could have for children around the world, in developed and undeveloped countries alike is amazing.

A very clear message

Nowadays, not too many people know who Myles Standish was. Those of an older generation will likely remember him as the military captain who was instrumental in the survival of Plymouth Colony. However, Standish seems to have been left out of most American History classes in the last thirty or so years, garnering at best a passing nod.

In the next month, schools across the nation will put on Thanksgiving pageants. Although a bunch of happy Pilgrims wearing belt-buckles on their shoes will be there standing next to a grinning Squanto holding up an ear of corn, it is doubtful that many kids will play the part of Captain Standish. This is a shame, because without Standish the Pilgrims likely would not have survived. Also, the man knew how to send a message, loud and clear.

Standish was not a Pilgrim. He was a military officer who had served in the Eighty-Years War and agreed to be the Pilgrim’s militia captain. As the military leader of a pacifist group living among American Indians who didn’t like them, Standish had a difficult job. The Indian confederacies that surrounded Plymouth (The Wampanoag, Narragansett, andMassachusetts) were understandably concerned about the foundling colony hugging the shore-line. Although it isn’t well known nowadays, the fact is that English boats had been fishingCape Codfor decades before the Pilgrims ever showed up. The Indians of the Northeast knew full well that the strange sickness that killed an estimated nine of ten people in the area had arrived at the same time that the Europeans had. Furthermore, those Europeans sometimes kidnapped the Indians. Squanto himself spent five years as a slave inEurope—that’s why he spoke perfect English when he walked intoPlymouthfor the first time in 1621, astounding the Pilgrim on-lookers.

As for the Pilgrims, they abhorred violence of any sort. It was a quality that did not help them much, given their situation. Luckily, they had Myles Standish. Although the Pilgrims could not have known it, the surrounding Indians were not just an odd conglomeration of Savages, but rather a culture with completely different—alien—social and political arrangements from what the Pilgrims were used to back inEngland.

In Britain, for instance, people showed their disdain for your politics by knocking on your door at midnight and hauling you away to a prison cell and an eventual miserable death.  The Indians of the northeast seaboard however, preferred to send a warning first. In fact, the warnings that they sent to each other were integral to keeping up the peace between the various tribes, clans, and war groups. American Indian culture consisted of an ever-changing set of social alliances that occupied a shifting geography of traditionally held territories. With all of the friction between these moving parts, conflict was inevitable. To prevent this conflict from becoming deadly, the northeast Indians developed a system of gift-giving. These gifts were important messages to the various tribes that allowed them to keep the peace. That isn’t to say that tribes didn’t occasionally drag people through the woods and do horrible things to them until they died—it’s just that they sent a greeting card first. They had to back up their talk, after-all. In all, it was a very good system of communication that allowed tribes to keep the peace: heed the warnings or suffer the consequence.

The Pilgrims received such a message, a big one. The Massachusetts tribe sent them a greeting card that basically said, “If you don’t leave, we are going to kill all of you.” For this, they used the traditional gift of a bundle of arrows tied together by a rattlesnake skin. It was delivered by a war chief accompanied by the strongest fighters. The Massachusetts knew how to send a message.

Although the majority of Englishmen there that day in 1621 would have had no clue what the gift meant, Myles Standish did. He had been too close to war for too long not to. He had survived the Siege of Ostend sixteen years before—some say the bloodiest siege in history. He knew that the Massachusettsmeant business, and he knew just how to respond. He took the bundle of arrows and snapped it in half with his knee. He then poured a handful bullets into the snake skin and handed it back to the war chief. It was about as simple, pure, and immediate as a message can be. Plymouth Colony survived.

Happy Thanksgiving.

This phone is packed with new features,  Siri voice control, all new A5 dual-core chip, a great new 8mg camera with new software to make it easier to use, and the ability to record 1080p video.  The release of iOS 5 brings its own set of new advancements, a reworked notification center, Twitter account intergration, Newsstand for magazine subscriptions, and PC Free which for the first time gives you the ability to set up a new iPhone without having to plug it into a computer.

So what is this major missing feature you may ask?   Is it missing some great new hardware?  Perhaps apple made a human factors mistake?  Is there an app to download and overcome this problem?  The answer to all these questions is no.  The missing feature is more of a standing problem with any smart phone.  The problem is in a word ‘voicemail’.  Whats wrong with voicemail?  Well if you are using your phone for business,  which most of us are,  the numbers are clear.  Over 75% of business callers hang up on voicemail without leaving a message.  Now it’s a gamble to think what these callers are doing next.  Sure some may just be waiting to call you back at a time when you will answer, or  even sitting down to write you that nice email.  I would wager that most are simply calling the next person in their google or phone book search,  that’s right they are hanging up on your voicemail to call your competition and give them the business that you would have gotten if only a person would have answered the phone instead of a  machine.
In our modern world filled with smart phones and over automation, it’s easy to get frustrated anytime a machine steps in to do a job we were expecting a human to do.  Don’t take that gamble with your customers, show them how much they mean to you by insuring they always speak to a person when they call your business.  Learn how to keep those customers that called you first by downloading our guide to Finding the Right Answering Service.

The Illusion of Good Communication

–George Bernard Shaw

George Bernard Shaw was an impressive man. He is mostly known today for his plays, such as Pygmalion, which served as the inspiration for the hit Broadway musical My Fair Lady. However, Shaw was also an important figure in literary criticism, journalism, and economics. That last one might seem a bit out of place. After-all, drama deals with emotions and feelings, whereas economics uses quantitative data to draw conclusions. However, Shaw saw an essential unifying truth about both the arts and social sciences; they both attempt to define how people interact with one another. In both his fiction and nonfiction works, Shaw dealt with how people attempt to get their point across while at the same time completely misunderstanding each other. He knew that communication was a very difficult thing.

Shaw wrote in the first half of the twentieth century, long before tweets, instant messages, even before email. Yet, he nailed the absolute indeterminacy involved with modern communication. Have you ever paused just before hitting “send” on that email to a friend or colleague? Why did you pause? Most likely because you didn’t know if your correspondence would be interpreted as you meant it. When Shaw wrote the quote that begins this piece, he was questioning whether or not people sitting across the dinner table could ever truly understand each other. Now, with the advent of instant electronic communication, his question has become infinitely compounded.

So what’s the answer? Obviously we can’t throw our hands in the air and refuse to communicate because we risk being misinterpreted. The trick is to understand that people will misunderstand you, and that you must get your point across anyway. If you keep these points in mind, the importance of good communication becomes elevated. When you have regard for those two things—the importance of your message and the ability of other people to get that message wrong—then you stand a better chance of your point getting across. If you don’t pay heed to how you frame your message in light of the intended audience, then you very well might be doing nothing more than creating the illusion of communication.

iPhone-Portable-ECG-Device

We are all aware of the amazing things that our smart phones are becoming capable of, but did you have any idea of the true scope of their capabilities?  One of the most recent and fastest growing segments of smart phone development goes hand in hand with the miniaturization of bio-medical monitoring equipment.

These developments will bring advanced bio-medical monitoring, previously only available in the hospital or with expensive hardware, into the homes of many.  The ability to monitor critical health information, and more importantly alert one’s physician to important fluctuations will potentially save lives and dramatically reduce health care costs.  The applications are endless, and the advantages priceless.

Following are three examples of what some developers are currently bringing to market.

Withings: The Smart Blood Pressure Monitor, Body Scale, and Smart Baby Monitor

AIRSTRIP Technologies : Healthcare Anywhere

AliveCor : iPhone ECG
 

The Shofar: The First Messaging Device

The Jewish New Year of Rosh Hashanah began at sundown on Wednesday, September 28, and will last through sundown on Friday, September 30. Although the Jewish calendar actually contains four new years, Rosh Hashanah is by far the most important. It marks the beginning of a ten-day period of reflection that culminates with Yom Kippur (Friday, October 7). The celebration is a festive and happy one, but is also a time to contemplate seriously one’s actions during the previous year.

Perhaps nothing is more emblematic of this holiday than the Shofar. The Shofar is an instrument made from a ram’s horn, and it used to remind Jews of their sacred obligations during the period that lasts from Rosh Hashanah through to Yom Kippur. As such, the Shofar is one of the oldest and most important messaging devices in history.  Each blast of the horn has a specific meaning. For the faithful, the difference in timbre and even time of day between Shofar calls carries a unique meaning. It is an interesting, inventive, and meaningful method of communication. To hear what the Shofar sounds like, go here . For more on the history of this spiritual communication tool, go here. Happy Rosh Hashanah, everybody!

General George Armstrong Custer

The history books are chock full of famous messages. Indeed, without the correspondences between people in the past, historians would have very little to write about; such sources provide us the information upon which our historical stories are based. Some messages have had great impact because they were so successful. Who can forget President Eisenhower’s beautifully simplistic, effective campaign slogan, “I Like Ike?” However, some messages are important because they failed at accomplishing their purpose. A great example of this is General George Armstrong Custer’s last dispatch before his Seventh Cavalry was wiped out in the Battle of the Little Bighorn. The message read:

”Come on. Big Village. Be Quick. Bring packs.”

Though brief, this message conveyed a lot of information. Captain Frederick Benteen, in command of Custer’s left flank, would have instantly recognized the importance of the message: a large number of aggressive enemies had been encountered, and Custer needed Benteen’s men and the ammunition packs that they possessed. Why, then, did the communiqué fail to save Custer? Historians, professional and amateur alike, have argued about this. Some have laid the blame on Benteen, others have said that the Sioux were just to powerful for Benteen to obey the orders. One thing, however, is beyond dispute: Custer’s lack of foresight in regard to messaging.

In short, Custer did not give much thought about messages between units before it was too late. Coordination between the various components of the Army had already begun to break down as long as a week before the battle. At that time, Custer had failed to receive any messages from his forward patrols. Instead of pausing due to the lack of communication, Custer moved forward. Furthermore, on the first day of the battle he had three different commands in the field—his, Benteen’s, and Major Marcus Reno’s. All were spread out along the Little Bighorn in about a four-mile line. Despite this, Custer retained only two messengers to communicate to his subordinates. For whatever else went wrong on that fateful day, the lack of a clearly effective communication system seriously aggravated the circumstances.

In a very direct way, Custer met his end because he did not pay heed to the importance of messaging until the Sioux were already shouting their war cry and crossing the river. At that point, a terse, eight-word message could not be decoded by Benteen in a way that could have helped Custer and his men. Had Custer not approached messaging as an after-thought, things at the Little Bighorn may have worked out very differently for him.

Many medical organizations preempt this by simply avoiding the issue. Mony Weschler, the ancillary informatics director at Montefiore Medical Center in New York City, provides an example of this approach. McGee’s article quotes Weschler thus, “We don’t store patient data on devices like smartphones and iPads.”

Though this policy is a good one for the present, how will it work in years to come? No blanket policy in the world will prevent your staff from transmitting information in the most expedient manner possible if the situation demands, and that is how it should be—especially in a sector such as the medical professions where so much information is time-critical. HIPAA regulations even make allowances for information that is shared during instances where timeliness is imperative (see: HIPAA and Natural Disaster: when is it appropriate to share medical records?). Instead of totally banning the use of newer, more portable communication technologies, the tact to take is to develop a sound, considered plan of integration of these technologies so that neither timeliness nor security is compromised.

Timeliness is an inherent quality of good communications, in *some* ways even more important than security. In fact, it may be reasonably argued that the advancement of communication is propelled by the invention of methods for *quickly* transmitting ideas, with the security of those transmissions as an after-thought which improves the general method. In a perfect world, timeliness and security would run apace of one another as communication technology progresses. However, that is simply not how the world works, and people use the technologies at hand. The fact is that, at some point, someone who works for you has probably already sent a text or sent an email from a smart phone that contains information that falls under HIPAA’s purview.

In the long run, we can’t expect this issue to go away. In a world that more and more relies on transportability of the work-space, people are not going to stop using their ipads and smart phones. In the medical industry, to do so is to potentially fall behind the competition. The trick is to make sure that the transition is made carefully and with fore-thought. The first thing to do is to familiarize yourself with what exactly HIPAA requires of communication security. To help with this, see 5 Questions to Ask About HIPAA Security. Though it is oriented towards selecting an answering service, it will provide you a good over-view of HIPAA compliance.

Anders Ynnerman puts all that data into context in a fascinating speech given at the November, 2010, TED conference.

Anders Ynnerman: Visualizing the Medical Data Explosion