REDMOND, Wash., April 29, 2002 — Here’s what a typical work week looks like for Dr. Peter Schock, senior partner at a four-physician primary care clinic in the Seattle suburb of Bellevue, Wash. On average, 120 of his 4,500 active patients come in for a visit. Over the telephone he cares for twice that many, dispensing advice, sharing test results, phoning in prescriptions and doing minor diagnoses that range from hay fever to sprains and strains. Schock also maintains a small pharmacy on-site for patients with severe infectious or painful conditions.
As if this workload weren’t enough, each patient interaction generates an average of eight to 10 pages of paperwork — everything from insurance claims to referrals to prescriptions. Multiply this by the number of patients a physician such as Schock treats every week, and it’s not difficult to see that doctors are among the most information-inundated professionals in a work world increasingly driven by data.
Of the 1,111 physicians surveyed for the 2000 Leadership Survey conducted by the Health Information Management Systems Society (HIMSS), 70 percent indicated that improving operating efficiencies was their primary workplace concern. “Using handheld technology gives us a tool to address some of the prescribing and time and motion challenges, which cost the medical industry dearly,” Schock says.
To help doctors like Schock better manage information and, in the process, deliver higher quality care, Microsoft teamed up with the American Academy of Family Physicians (AAFP) to evaluate nine practice-management software programs. “Practice management software” is the term for software developed specifically to increase efficiencies by automating billing, insurance claims, appointments and other office tasks.
The resulting software guide, announced late last week at the AAFP’s Annual Leadership Forum in Kansas City, Mo., offers doctors the information they need to determine what software works best for their practice. In addition to the Practice Management Guide, Microsoft continues to partner with hundreds of vendors to develop software that’s easy to use and competitively priced for all segments of the healthcare industry.
The vendors’ software was subjected to intensive review in the functional, technical and financial/corporate areas. The functional evaluation determined the presence or absence of 57 key functionalities. The technical evaluation included an on-site visit by a team of technical experts from Microsoft to the vendor’s premises, detailed discussions with the vendor’s technical team, a close examination of the architecture of the product, its design, and the methodology for building and testing it.
Over the course of more than two years and based on the needs and requirements of family physicians, Microsoft and the AAFP evaluated the practice management software on criteria including:
The quality of software functionality
How well it meets the needs of family physicians
The quality of the software’s technical architecture
The reliability of the software
The maker’s use of industry technology standards
The financial viability of each vendor.
Vendors evaluated in the guide include Compusense, e-MDs, Greenway Medical Technologies, InfoSys, MedStar Systems, NextGen Healthcare Information Systems, Millbrook, PerfectPractice.MD and Visionary Medical Systems (for Web sites, see Related Links at right). Both Microsoft and the AAFP consider the report a buyer’s guide rather than an endorsement of specific products.
Microsoft’s Commitment to Healthcare
“Healthcare deals with the most complex organism in the world — the human body — and that’s not a simple thing,” says Ahmad Hashem, M.D., Ph.D., Microsoft’s manager for the Global Healthcare Industry. Hashem says that Microsoft’s commitment to the healthcare industry — and specifically doctors — is the result of increasing demands for healthcare solutions that seamlessly and securely integrate with and expand an organization’s existing infrastructure, and that close the gaps in the continuum of care. Web-enabled technology, Hashem says, is an ideal vehicle for sharing information across the healthcare spectrum on a wide variety of devices.
Technology also cuts down on paperwork.. Hashem knows first-hand how the complexities of paperwork can bog down a medical practice. The Microsoft executive practiced medicine for two years before going back for more schooling, eventually earning a doctorate from the University of Pittsburgh in medical informatics — a relatively new field that focuses on how technology is applied in healthcare. “Healthcare is already complex, but we make it more so by adding layers of administrative complexities,” he says.
Take insurance, for example. Most of the 1,500 insurance providers currently doing business in the U.S. have their own systems for accepting and processing claims, meaning the provider must negotiate multiple formats.
And then there are hospitals, where Hashem has seen often-crucial patient information scattered across multiple systems. “The healthcare provider doesn’t have access to the full picture without going into four systems,” he says. While having data stored in multiple places in multiple formats is sometimes little more than a nuisance and a waste of time, the problem has the potential to be far more damaging. A study reported by the Institute of Medicine found that up to 98,000 people die from medical errors in U.S. hospitals each year.
Hashem says Microsoft chose to focus on technology used by doctors because of their proximity to the point of care. To understand the concerns and challenges physicians face, Hashem says Microsoft maintains strong relationships with professional associations and leaders in the field. In fact, Hashem estimates that he interacts with some 10,000 physicians a year by traveling to hospitals and clinics and by attending conferences around the globe. “Everything and everyone in healthcare is important, but doctors have an edge,” he says. “At the end of the day it’s all about a doctor treating a patient. They play an extremely fundamental role — they’re where the rubber hits the road.”
Technology and Healthcare: A Natural Fit
Dr. Warren Jones, president of the 93,500-member AAFP, says the partnership has been a natural fit since its inception. “The reason this marriage came to be is that we’re the largest specialty medical association and Microsoft is the leader in innovative technology,” Jones says. “To lower costs, increase efficiency and the quality of patient care and to decrease frustration, doctors need clear, easy-to-find information about the technology that’s best for them.” The guide, Jones says, will make it easier for doctors to make well-informed, strategic choices about technology.
Jones is also a clinical professor at the University of Mississippi Medical Center’s Department of Family Medicine. Prior to that post, he served with the U.S. Navy as medical director of a health system with 10 million beneficiaries. Jones says his experience in a full spectrum of clinical and military settings, coupled with teaching experience, has given him a keen appreciation for the significance of technology — especially to healthcare providers in smaller practices, who often lack the resources and access to networks available to physicians who work in larger settings.
“I really appreciate and understand the need for technology,” he says. “I like the technology, and I like what it’s doing. I think the guide we developed is a good first step in our mission to help physicians function more efficiently and deliver better patient care.”
Putting Technology to Work in the Clinical Setting
Schock can vouch for technology’s ability to help physicians deliver better care more efficiently. He uses a personal digital assistant (PDA) with a radio frequency card that’s tied to a Windows XP-powered PC, which is in turn tied to phone lines for faxing prescriptions and for downloading up-to-the-minute, prescription-specific data. With the explosion of information currently facing the medical field, Schock says, having a reliable means for sorting through updates and new research is key.
A software program from Allscripts Healthcare Solutions conducts a five-way check on whether Schock’s diagnosis matches the treatment he’s chosen, if the dosage is appropriate for the condition, if the prescription is likely to cause an allergic reaction, or if there are other drugs the patient may be taking that would cause an adverse reaction.
Schock’s handheld PDA is constantly refreshed with new information from his PC. This ensures that he and his patients have current information in the examination room. “It gives me an edge over doctors who don’t have PDAs,” he says.
For patients, Schock believes his system is both a means of convenience and a cost cutter. “As we’re talking I can generate an order to the pharmacy, which means the prescriptions are ready when they get there,” he says. “They don’t have to wait.”
In terms of savings, Schock’s technology helps him navigate the complex rules, regulations and conventions that govern prescription-drug pricing. Different tiers have different co-payments; a non-sedating antihistamine, for example, may cost the patient twice as much as an antihistamine that does sedate. Or, a certain insurance program may have purchased 1 billion antihistamine pills from a pharmaceutical company, meaning that they can sell them cheaply. And, of course, this data — like airfares and interest rates — changes often.
For patients, the technology ensures that theynot only get the most medically appropriate prescriptions but the most affordable as well. “I am trying very consciously to contribute to cost savings,” Schock says. “If I waste my patient’s money by prescribing incorrectly, I’m contributing to the duress caused by the always-rising pharmacy costs.”
Schock looks forward to the day, not too far in the future, when all of his systems are integrated. His accounting, demographics, patient records, insurance and pharmacy-related data will all interact and integrate to provide Schock and his patients the information that he currently has to visit several sources to obtain.
While Schock looks forward to the day when more of his practice’s procedures are automated, he says he has realized benefits by simply automating the prescriptions function. “Throughout the healthcare system, we can all benefit from using technology,” he says. “My highest motivation is for my patients, and I believe technology helps me help them better.”