Online Reputation Management for Doctors
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Online Reputation Management for Doctors
Curated and Written Articles to help Physicians and Other Healthcare Providers manage reputation online. Tips on Social media, SEO, Online Review Managements and Medical Websites
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How to Improve Patient Engagement in the Provider Community

How to Improve Patient Engagement in the Provider Community | Online Reputation Management for Doctors |

Patient engagement strategies have been heavily discussed in the media and among the vendor community, but digital participation on both the provider and patient side has been meek at best.

The latest report from Chilmark Research on the patient engagement market shows that the healthcare sector is still participating very minimally in digital communication with patients post-discharge or between visits.

In an interview with, report author Naveen Rao from Chilmark Research spoke about the potential of patient engagement for bringing broader models of care to the industry. More outreach is especially helpful for patients with chronic conditions or severe illnesses.

“We wanted to find out — what are people actually using today. Not what’s actually being sold but what’s being bought. We wanted to find out from the provider’s perspective, what are the limitations of the tools that are being purchased,” Rao revealed.

“Usually, there’s a feature or two that are dedicated to engagement,” he continued. “So we wanted to look at those features and see whether they are actually working. Are they cutting edge? Are they not?”

Specifically, Rao mentioned the benefits of mobile technology in the healthcare market. While some vendors have mobile-compatible apps, there is very limited device integration in healthcare. The provider side is not much better, as few physicians are utilizing mobile health technology to improve patient engagement. However, mobile health apps could improve administrative aspects of care such as faster scheduling as well as managing post-discharge care.

“If you look at the state of affairs when it comes to mobile tools for the patient in the year 2015, it’s pretty disappointing, particularly on the provider side,” Rao stated. “Providers don’t acknowledge that there’s this really great tool that every one of their patients is leaving the office with. They can and ought to be leveraging [it] a little bit more effectively.”

The most common tool in patient engagement is the patient portal. Some aspects that Rao encourages health IT vendors to include in the patient portal are mobile health tools and the longitudinal patient health record that is connected to their EHR. Additionally, health information exchange (HIE) capabilities that can pull in data from other hospitals across the country would benefit the patient portal greatly.

Patient-generated information and biometric data like blood pressure and diabetes management analytics could also be incorporated into patient portals and EHRs. However, vendors will need to move more quickly to incorporate some of these tools into the patient portal.

“We have the technology to send information and collect it from point A to point B,” Rao mentioned. “It’s not happening. There’s no way to put it [biometric data] into your record. Five or ten years from now, things are going to become more digital. The vendors out there aren’t really with the program.”

The Chilmark Research report focused on how the average providers are lacking effective patient engagement strategies. For providers who haven’t begun incorporating patient portals, Rao said the first step to take is to improve patient-doctor communication. Physicians should speak with their patients to find out their preferred method of contact.

After an appointment, doctors should follow-up with their patients via secure messaging/email, text, or phone call in order to enhance communication. After “mastering these basics,” providers should implement patient portals to improve patient satisfaction.

“There is a lot of capability possible through just a basic patient portal. That’s not exactly the most advanced tool that we have today, but it’s a great starting point,” Rao said. “Providers have the ability with their patient portals to send secure emails. But are they actually doing it?”

“Are you actually sending messages to patients between visits? If someone comes in with lower back pain, you send them home with a pill and you never follow up… when it comes to advanced models of care, we can use email to do a lot. If the doctor isn’t doing simple things like sending a follow-up, then what’s the point of having this technology in the first place?”

Providers will need to put greater emphasis on patient-doctor communication and follow-up contact in order to improve the quality of healthcare services. Naveen Rao also spoke about the type of health IT tools providers can utilize when gathering population health statistics. These include data management, data analytics, and stratification tools as well as information exchange and registry capabilities. Digital and mobile health applications can also play a lesser role in population health management.

Rao mentioned that telehealth and mobile technology will have a “big impact” on the healthcare industry in the coming years. He sees it become adopted more broadly in the next three to five years. The most important aspect, though, is to ensure multiple physicians can access the same patient records in real time. Telehealth services will have a strong, transformative influence on rural healthcare as well as patients with weather and geographic limitations.

As a greater shift toward population health management and patient engagement takes place, the healthcare industry will see providers rely more on multiple IT vendors. This is likely because a single vendor rarely is able to offer every single aspect of medical technology. This offers physician practices positive opportunities such as reducing the issues associated with limited EHR systems. However, with all benefits, come some disadvantages like more staff training, higher workload, the costs associated with new systems, and the overall responsibility of working with multiple vendors.

Physicians who are looking to increase patient engagement should consider the following strategic steps. First, find out a patient’s preferred method of contact. Next, partake in the patient activation measure, which essentially means work toward improving patient interest in their medical care and treatment protocols.

Doctors can also improve patient satisfaction by checking in and following up after an appointment. The last step to incorporate is patient-reported outcomes by recording data after receiving secure messages. Physicians looking to improve communication with their patients should consider implementing this patient engagement strategy.

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Why You Should Have a Dress-Code Policy in Your Medical Practice

Why You Should Have a Dress-Code Policy in Your Medical Practice | Online Reputation Management for Doctors |

During a meeting this week, I decided it was time to touch on the practice's dress-code policy. This policy should be reviewed about once a year. I had heard from some of the front-office staff members that patients were making potentially inappropriate comments about their clothing, such as, "That shirt looks really nice on you," and "You have great legs, you must work out."

Although these comments may seem harmless to some, they can be the cause for all sorts of disasters (for both staff members and the practice) — especially if management had been approached. It is your responsibility to protect your employees from patients who choose to verbalize thoughts that should be kept to themselves. Having a solid dress-code policy in place is your first line of defense.

If you are not sure where to start, or what to include in your dress-code policy, here are some ideas:

• Employees are expected to dress in an appropriate, professional manner that portrays an image of confidence and security for patients. Cleanliness and neatness are absolutely necessary at all times. Distracting themes in appearance or dress, low-cut clothing, exposed midriff, evening wear, or sheer clothing are unacceptable.

• Clinical staff will wear collared shirts or scrubs, non-denim slacks, and closed-toed, non-sneaker shoes. A nametag will be worn if the name is not embroidered on the company shirt/scrubs.

• Front-office staff should dress in "business casual." They are required to wear nametags or company shirts. As stated above, distracting items in appearance or dress, low-cut clothing, exposed midriff, evening wear, T-shirts, or sheer clothing are unacceptable. Business-like open-toed shoes may be worn, not to include flip-flops or beach sandals.

• (Your practice name) and its directors reserve the right to ask employees who are not dressed in what is deemed a clean and professional manner to change their attire. Failure to comply with the policy will result in being sent home without pay. Further infraction will result in written disciplinary action as decided by the directors.

• Appearance and perception play a key role in patient service. The goal is to be dressed professionally; any employee with body art must ensure that it is covered at all times.

There is a time and place to express staff members' personality, and the workplace should not be that location. If employees follow these types of guidelines and patients still make inappropriate comments, take the offending patient aside, privately, and share your concerns about inappropriate conversation.

It's also important to note that if nine out of 10 employees follow the dress-code policy, and you have one outlier, taking that employee aside and reviewing your policy in a private conversation is much more appropriate than including the entire staff.

The dress-code policy is in place not only to protect your staff, but also to protect your practice. Comments made by patients can be construed by staff as sexual harassment, and contribute to a "threatening work environment." It is up to you to make sure these types of scenarios never happen. In the event they do, have a solid dress-code policy to land back on.

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An Inside Look at What’s Trending in the New Healthcare

An Inside Look at What’s Trending in the New Healthcare | Online Reputation Management for Doctors |

Every year, B. E. Smith, a Lenexa, Ks.-based healthcare executive search firm,  analyzes its surveys of more than 300 healthcare leaders, and partners with the American Hospital Association (AHA) on an environmental scan that reflects upon the most crucial trends expected to impact healthcare leaders through the new year and beyond.

The 2015 Healthcare Trends white paper identifies nine trends that span a range from institutional realignments, new competitive forces, patient demands, population health implications, and workforce development and engagement needs. Through all of this, B. E. Smith executives say that one point stands clear—the current environment, in all of its complexity, stands to greatly impact leadership planning, strategies and technologies to adapt to this ever-evolving landscape.

Recently, HCI Associate Editor Rajiv Leventhal spoke with Laura Musfeldt, vice president of senior executive search, and Mick Ruel, vice president of executive search about the white paper, and the IT and policy-related trends that will affect patient care organizations nationwide as they move forward in the new healthcare. Below are excerpts from those interviews.

What were the most significant  trends you found related to IT and policy?

Mick Ruel: What I found most significant is how technology and technical solutions are being tied more into clinical results, as well as the drive for better results and better quality outcomes. Things will vary from organization to organization, but the trend is utilizing the data. Healthcare has always done a great job of collecting data, so now what do we do with that to help drive towards better clinical outcomes?

Laura Musfeldt: In addition to that, when you think of federal policy, we have had the Health Insurance Portability and Accountability Act (HIPAA) in place long enough now that we really can ensure privacy for patients. That will allow us to move forward with having a direct dialogue, as you can log into a portal and ask a question and get a response back. We have advanced enough to be able to do that. We can measure quality outcomes, and that’s driving things from a reimbursement perspective. Those organizations that have good data on what their outcomes are will be in a stronger position as they negotiate with payers. It’s a win-win for everyone.

Ruel: Yes, you’re seeing more healthcare leadership with the change in reimbursement models—leadership has had to take a key role in developing policy in helping the organization overall in the new reimbursement model.

How are organizations doing a better job of “utilizing the data”?

Ruel: You have clinicians who have taken the lead in understanding the data and applying that back to generate better outcomes. Physicians are getting more involved in that, rather than telling them what the scorecard is afterwards, which is what used to happen. Then they started using that data to make decisions proactively in advance for better outcomes. That’s been the trend until recently, and now you’re starting to see healthcare leaders get involved because of the way they’re going to get paid and the way revenue is going to be generated. They’re taking the key role. You had scorecards that told them how they played and what they had done, and now they’re using that to drive how they do things before they get involved in decision-making clinically.

How are providers reacting to the shift to a value-based healthcare, when they’re still getting paid in a fee-for-service model?

Ruel: What I have seen from our clients is that even if they are being reimbursed that way, they’re being proactive, knowing that the landscape will change. Steps are being taken now to make that transition. Dollars are to be had even now, if you can provide outcomes-based service, or avoid service with population health.  That’s probably the biggest key and change. Smaller organizations that can be nimble are doing that sooner, while larger health systems are looking for ways to reduce expenses in preparation for lower reimbursement.

Musfeldt: I do quite a bit of work with physician leaders, and every one that I talk to is really paying attention to evidence-based medicine. Decisions are being made by that collective database that tells us, for example, when is the right time to give that antibiotic to the patient before he/she goes to surgery? They know that, but now they can put mechanisms in to ensure that it happens. They might not all be at risk now, though their thinking is in line with that.

So you aren’t seeing pushback from providers?

Musfeldt: I’m not sensing that, because these are savvy, smart leaders, who understand the risk factor. That’s increasing every day—physicians will be on risk-based reimbursement just like the hospital is. So if they don’t follow evidence-based recommendations, they will be the outlier. They don’t want that, they want to hit it right every time. I don’t see pushback.

How are mergers and acquisitions affecting the landscape?

Ruel: I don’t know if they’re affecting things, but you are seeing the fear of a smaller reimbursement coming, so how do we streamline and become more efficient? I’m working with some independent hospitals, and they would like to stay independent, but as much as they want to, there has to be some relationship and affiliation by their choice or not. So I don’t know if M&As are affecting the landscape, as much as the landscape as allowing more of that to happen.

What are the biggest concerns of healthcare organizations as we move forward?

Ruel: The uncertainty about the future is the biggest thing I’m seeing from my clients in terms of fear. We know what’s happening, where it’s all going, but how will it impact us? How will we be reimbursed, will we remain independent? That’s what I am hearing. Having to deal with all of those things and not knowing how it will affect the way they do business today is the biggest challenge.

What key pieces of advice would you offer healthcare organizations as they forge ahead in 2015?

Musfeldt: This is where leadership comes in—a strong leader will anticipate and develop the next generation plan. The most successful ones are the ones investing in IT leadership, and that includes physicians being part of that decision making at the high end.

Ruel: You better embrace the change and have the leadership to adjust to the changing landscape. Physician engagement is getting there, but it’s not where it needs to be. It’s all about clinicians, in a broader sense, how they tie in technology, and finance into deliverables to patients. That’s the key moving forward. Leaders that embrace that get it. We’re seeing more turnover in the CFO role, and we’re seeing the CIO role evolve into more of a strategist with the organization, rather than providing technology like they traditionally have. I can’t talk enough clients into creating a CMIO position, I think its critical. They better find a physician champ that supports and understand technology.

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Can forces align to use health IT to improve care and lower costs?

Can forces align to use health IT to improve care and lower costs? | Online Reputation Management for Doctors |

Health information technology (health IT) is essential to providing clinicians and patients with the information and tools necessary to make decisions that can improve health outcomes and lower costs. While the 2009 Meaningful Use program (included in the federal stimulus package) and other initiatives have increased the adoption and use electronic health records (EHRs) there are many concerns about the benefits of health IT and the future of health IT policy. These concerns are particularly timely given the recent U.S. Department of Health and Human Services announcement to expand the use of value-based payment models in Medicare, as well as the release of a national roadmap to achieve interoperable health IT. Likewise, in the private sector, many organizations are shifting to value-based payments and are developing innovative products and services to capitalize on the potential of health IT.

On March 4, the Engelberg Center for Health Care Reform hosted an event to discuss the current state of health IT adoption, its potential to reinforce a quality and value-based payment system, and identify which policy changes will be necessary to support meaningful health IT transformation. The discussion included keynote remarks from Karen DeSalvo, National Coordinator for Health IT, U.S. Department of Health and Human Services, as well as health IT and other policy experts.

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'Mix and Match' Documentation for Higher Reimbursement

'Mix and Match' Documentation for Higher Reimbursement | Online Reputation Management for Doctors |

Recent changes in how CMS permits you to select evaluation and management (E/M) service levels are a benefit to providers who manage patients with multiple chronic conditions.

E/M services may be provided at various levels of intensity, with more intensive services garnering higher reimbursement. E/M service levels (and the codes that describe them) are assigned according the elements of patient history, exam, and medical decision-making (MDM) documented in the provider’s encounter notes.

CMS allows you to choose between two sets of guidelines when translating provider documentation into E/M codes: The 1995 Documentation Guidelines for Evaluation and Management Services and the 1997 Documentation Guidelines for Evaluation and Management Services. The guidelines differ in how they define the history and exam portions of an E/M service (the guidelines are identical regarding MDM).

The ‘95 guidelines define the exam component such that specialist providers found it difficult to report higher-level E/M codes, even when services warranted doing so. The ‘97 guidelines addressed this issue by providing bullet points for single organ system examinations, thereby allowing specialists to report higher level services for intensive, problem-specific exams. The ‘97 exam requirements tend not to work as well for general practitioners, however.

The ‘97 guidelines also differ in the history component, and allow “the status of three or more chronic conditions” to qualify as an “extended” history of present illness (HPI). Under the ‘95 guidelines, providers must document four or more HPI “elements” (location, quality, severity, duration, timing, context, modifying factors, and associated signs and symptoms) to attain an extended HPI.

Each set of guidelines has its advantages and disadvantages. For many providers, the ideal guideline would combine the ‘95 exam requirements (which are more subjective, as compared to the ‘97 exam requirements) with the ‘97 history element (which are more flexible than the ‘95 guidelines when defining the history of present illness). For many years, such “mixing and matching” of the guidelines has not been allowed.

Effective since Sept. 10, 2013, CMS has revised its E/M Documentation Guidelines to allow an extended HPI, as defined by the ‘97 guidelines, with the other elements of the ‘95 guidelines. As a result, “the status of three or more chronic conditions” qualifies as an extended HPI for either the ‘97 or ‘95 guidelines. 

CMS announced the change as a “Question and Answer” on its website.

Q. Can a provider use both the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services to document their choice of evaluation and management HCPCS code?
A. For billing Medicare, a provider may choose either version of the documentation guidelines, not a combination of the two, to document a patient encounter. However, beginning for services performed on or after September 10, 2013 physicians may use the 1997 documentation guidelines for an extended history of present illness along with other elements from the 1995 guidelines to document an evaluation and management service.

CMS has also updated its Evaluation and Management Services Guide to reflect the new policy.

Ask your coding staff if they are aware of this change, and if they are measuring E/M services against the revised guidelines. Those physicians who manage patients with multiple chronic conditions, especially, may find that the new rules allow their coding and billing to better reflect the documented level of service provided, thereby legitimately boosting E/M levels and reimbursement levels. If providers are already documenting their services well, they won’t have to change their process to realize an advantage from these revised E/M guidelines.

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Efficiency of Remote Clinical Documentation Improvement Work

Efficiency of Remote Clinical Documentation Improvement Work | Online Reputation Management for Doctors |

Would working remotely on clinical documentation improvement (CDI) improve efficiency at a healthcare organization? Some may not think so, but the results from Baystate Health indicate otherwise.

As part of its CDI program, Baystate Health in Springfield, Mass., began teaching CDI specialists to work from home with the help of health IT tools, according to the Journal of AHIMA.2014-10-15-Doc-at-PC

So far, working remotely has led to greater accuracy and efficiency among CDI employees. Several years ago, the organization began expanding its CDI hiring base and moving some staff members off-site.

By 2014, the CDI team rose from four specialists to ten. The original four workers were transitioned to working from home after establishing strong relationships with physicians and coders when working on-site. Both email and EHRs were used to run queries by CDI specialists working from home.

This allows providers to focus on their patients and get back to documentation questions afterward. Essentially, it brings better care to patients by preventing interruptions to workflow.

Often, CDI specialists work on hospital floors and ask physicians or nurses directly about queries, but supervisors explain that little has changed by allowing this work-from-home program. The health information management department has also developed software that allows CDI workers and coders to communicate about cases and records.

Another useful tool that simplifies working remotely is an instant messaging platform the organization incorporated. This system-wide messaging capability allows CDI specialists to pose questions and manage issues with anyone from Baystate Health, whether it is the billing department, the health information management department, or medical and surgery.

“We don’t interrupt the productivity of our individuals by having them pair or mentor off another individual, but we use these tools to understand where the variations lie and where there’s other opportunities,” Jennifer Cavagnac, CCDS, Assistant Director of Clinical Documentation Improvement at Baystate Health, told the news source.

One of the main reasons that the organization introduced working remotely was to improve job satisfaction. Moral in the workplace rose due to increased flexibility. This also led to better retainment of top CDI employees.

Cavagnac goes on to explain that team members who work remotely are encouraged to communicate with the rest of the team and ask questions about cases in order to keep them connected to the workplace. The supervisors attempt to ensure workers don’t feel isolated and that resources are available even when working remotely.

Technology like instant messaging, EHR systems, and telehealth services has not only allowed employees to work remotely but also enabled patients to receive basic healthcare assistance outside of a medical office.

The Federal Times reported that caregivers are able to reach patients on a daily basis through telehealth services but a more integrated system will need to be developed so that patient data can be stored securely and shared in real time.

The Department of Veterans Affairs (VA) began a telehealth network four years ago in order to provide healthcare services in rural areas without a strong hospital system. The medical industry will continue to adapt and improve technologies such as videoconferencing, image storing, and wireless communication in order to strengthen the capabilities of telehealth.

Whether it is to increase work flexibility or improve telehealth services for patients around the nation, technology plays a vital role in connecting individuals across the healthcare spectrum.

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Population Health Would be Easy, If it Wasn’t for Our Patients!

We get so caught up in our day to day work that we often forget what it is all about. We focus on the technology and clinical side of Population Health, but there is another aspect that is harder to control; Patient Compliance. One of the agenda items at a Physician Group Board meeting I attended included the dismissal of patients. These were primarily patients that had been abusive to staff or had failed to meet financial obligations, etc. On some occasions we had patients that failed to follow through on the provider orders and was placing their health at risk.

These situations are difficult. On one hand the provider cannot stand idle as they watch a patient ignore medical advice and jeopardize their health. On the other hand, you don’t want to leave the patient without medical options. These are often elderly patients that may not have a family member helping them navigate all the treatment decisions or translating the medications and therapies to layman terms. They are also patients that have a surgical procedure and fail to attend or complete physical therapy, severely affecting their range of motion or quality of life. Then there are also patients that are non-compliant with drug therapy or maybe they never scheduled the specialist referral.

Population Health will be tracking various provider metrics and could reflect if a patient is consistently showing non-compliance with prescribed therapies. This has the benefit of identifying those patients with certain special needs. These can include language barriers; help with navigating the healthcare system, or patients with transportation problems. There are also patients that can’t afford the deductibles, or co-pays associated with therapeutic treatment or medications. Some patients are either too proud or too uncomfortable talking to the providers about these issues.

In the physician group that I worked with, they had very solid policies and procedures with specific escalation points to deal with non-compliant patients. Often it only took a friendly letter to say that you are concerned about their health and maybe offer someone on staff to schedule their referral or go over the treatment options that were presented. Of course all the letters and policies had to have a legal review. You also had to have the information technology systems that tracked, flagged and even produced alerts to providers when someone missed appointments.

Population health cannot just include what we are doing on the clinical side, we must understand what unique issues our patients are having and help them make the right treatment decisions. Often these include an advocate or patient coordinator. However, sometimes it may also include a letter stating that they cannot continue to ignore medical advice. It is always an uncomfortable conversation for the staff and patients. However, it is at the core of the goals that we set for improving clinical outcomes.

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Informatics Expert on Interoperability: “We’re in the Dark Ages”

For healthcare organizations, challenges to interoperability include getting consistent and timely response from electronic medical record (EMR) vendor interface developers, financial costs of building interfaces, and technical difficulty of building interfaces. Undoubtedly, many have classified the state of interoperability in healthcare immature as vendors and providers continue to try to work together to make all systems interoperate, while the call for more direction from the federal government has been made.

What’s more, medical image exchange across the enterprise presents its own set of challenges, as historically, medical image storage has been under the control of individual picture archive and communications system (PACS) applications, requiring management of that data to be completely reliant upon system functionality. To this end, David Avrin, M.D., Ph.D., vice chairman, informatics, professor of clinical radiology, department of radiology and biomedical imaging at the University of California, San Francisco (UCSF), will be part of an interoperability panel discussion at the iHT2 Health IT Summit in San Francisco on March 3, 2015 (the Institute for Health Technology Transformation, iHT2, is a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC).

Dr. Avrin and others will discuss the best practices for data exchange at their respective organizations, addressing how organizations are working with regional health information exchanges (HIEs) and vendors, and what’s on the horizon for interoperability. Click here to register for the San Francisco event. Avrin recently spoke with HCI Associate Editor Rajiv Leventhal about what’s holding the industry back from being more interoperable. Below are excerpts from that interview.

Interoperability is clearly a huge healthcare buzz word these days. Where does your organization stand when it comes to data exchange?

We have been successful with integrating in-house vendor/provider applications. All of our principle apps—our PACS system, radiology system, Epic’s Radiant, and PowerScribe—are tightly integrated. Take abdominal imaging for example, a patient’s medical record at UCSF opens up in a second, and you are one click away from seeing the entire record and notes by date or by category. We have achieved that through a requirements and specifications process, and customer assistance with these vendors. Certain vendors know they need to interoperate. That works well.

Here’s what does not work well: as an academic medical center, we get patients from elsewhere, which might include Sutter Health, Oakland Children’s, Kaiser Permanente in northern California, or whoever.  If you’re dealing Epic to Epic, for example, to Kaiser in northern California, sometimes with the right permissions you can get read-only access into Kaiser’s medical record, but you can’t bring over things like medical lab values automatically.

We also receive patients from community physicians, and in spite of meaningful use, we still have a terrible time with electronic records or any records across care boundaries from the outpatient world into the inpatient world and back again. It’s a mixed world, and it’s getting a little better because customers are insisting more, and vendors know they have to do a certain amount. But it’s far from perfect, far from what many hoped would happen. There’s a lot of finger pointing going around. It’s in the community hospitals’ interest to share data, but data really belongs to the patients, not the hospitals. Vendors say there aren’t well-accepted standards, and they also take advantage of the fact that the neither the customer base nor the government have done a good job with insisting to adherence to Health Level Seven (HL7) Version 3 or Logical Observation Identifiers Names and Codes (LOINC), or whatever. Outside of healthcare, they have had a simple time with electronic data exchange. We are still in the dark ages.

You mention finger pointing, so where does most of the onus lie?

The majority of the onus is still on the community hospitals now for two reasons: they haven’t done a good job of making demands, and also too many community hospitals view patient information as their proprietary property, their marketplace advantage, and are not motivated to share it. Vendors would go along if the customers were more progressive. Another thing is there is no national medical record number for patients. The Veterans Administration (VA) uses social security numbers for patients, yet every other industry does it differently.

Also, meaningful use was a great opportunity for the government to guide the adoption of certain standards and XML cloning of data. I think the federal government blew it with Stage 2, as interoperability was supposed to be a huge part of it. That was not well done. It was a real missed opportunity to force some standards development. HL7 could simply things, and it needs to recoup.

There’s a story I like to tell about a seminar that I teach at the medical school here at UCSF on problems with EMRs. So we go around the room to get background on where the students come from, their interests, if they work, etc. One person actually said he’s a CTO of an EMR company, so I said tell me more. He said his company provides 90 percent of the university clinic outpatient healthcare records in the U.S. I asked him how they got their solution certified, and he said for Stage 1 requirements, to transmit records electronically, all you had to do was put it in PDF and email it. That’s not interoperability. Interoperability is XML-tagged data.

Can Stage 3 fix some of this?

Well, there is the new 10-year interoperability vision now, but I don’t think any stage of meaningful use will do it. They simply blew it. In terms of making this an interoperable world, we haven’t gotten there and it’s our own fault. Providers need to be insistent, community hospitals can’t get in the way, and vendors, including the Epics of the world, need to be more responsive.

Regarding image exchange, what are the most advanced organizations doing?

One of the most advanced HIEs in the country is in Kansas City, so if you show up in an outpatient imaging center or hospital in the Kansas City metro area, they have an opt out strategy meaning you’re automatically opted in. Your images, your finger X-ray, and the report are available throughout the area. Is that okay with you? Ninety-five percent or more people say yes, and if you say no, here is what you have to read and sign. That’s what opt out is. They have one of the most successful HIEs in country that includes exam reports and image exchange, so we need to follow that model nationwide. You love the world where everything about patients pops up in a second, as you should.

How do you envision the state of interoperability five years from now?

 We just want all vendors to be able to talk to each other with open standards, and I think that problem will be solved in a few years, less than five years. The biggest complaint you hear is that “I don’t want hospital X to get stuff from my archive without me knowing it.” If it really belongs to the patient though, that shouldn’t be a problem. But it is a problem. We haven’t achieved this permanent, built in transparency to get rid of requesting and moving the CD, but we’re getting there. Mark Kohli is a guy who has my job at Indiana University, and he refers to the International Standards Organization (ISO) seven layer model, where the top layer is programs that look like they’re talking to each other, with the bottom layer being an Ethernet cable. But there is an 8th and 9th layer, Kohli says, that is politics and money. And more than money, it’s about agreeing on technologies and a set of XML tags. There is a lot of politics involved, and we could have used help from the government there regarding meaningful use. Unfortunately, we didn’t get it.

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How to Apologize for a Medical Error

How to Apologize for a Medical Error | Online Reputation Management for Doctors |

Apologizing to a patient when an error occurs is critical to reducing malpractice risks, says Sue Larsen, president and director of education at Astute Doctor Education, Inc. "They always say that anger and not injury is what drives a patient to sue, and everybody hates a cover up," she says. "So when something goes wrong and the physician goes missing, that's when the patient feels deserted and they suspect that something has gone wrong." Ultimately, Larsen says, that anger and the resulting broken relationship with the physician can propel the patient to sue.

Of course, apologizing for a medical error is not easy, and Larsen says how you say sorry is crucial. Make sure your apology is:

• Sincere;

• Empathetic; and

• Indicates mutual disappointment.

"As a doctor, you are disappointed in the outcome and you are sorry the patient is disappointed as well," says Larsen. "This isn't admitting fault, it just is a way of showing the patient that you care and that you understand."

Once you make the apology to the patient, emphasize that you are committed to ensuring this error will never happen again, and that you are going to follow up to determine why the error occurred.

Then, attend to the patient's immediate needs that you can address, says Larsen. "Avoiding the patient or deserting the patient is absolutely the worst thing you can do, and it's going to put you at a much higher risk of having a claim made against you."

To help you determine the right approach next time you need to make an apology, Larsen shared this example of the proper phrasing to use:

"I'm really sorry this has happened to you, it's obviously not the outcome that any of us would have liked to have seen. I'm disappointed. I'm disappointed that you have had to go through this. I know that you are feeling very upset and frustrated that this has happened and perhaps even quite angry, and I can understand that you'd be feeling that way. All I can do is say I'm sorry that you are in this situation and we are going to do everything we possibly can to try and understand the events leading up to this so that we can avoid it happening again. In the meantime, I'd like you to know that I am here for you, if there is anything I can do."

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3 Things Doctors Can Do to Connect With Patients

3 Things Doctors Can Do to Connect With Patients | Online Reputation Management for Doctors |

Patients have been coming into my office for several years telling me that they looked me up on the Internet and that I have great reviews. I always dismissed these comments, as I knew that these reviews were influenced by many factors and not necessarily accurate. Plus, the reviews were favorable so I gave it little thought. Eventually, I took the opportunity to Google myself and was amused by much of what I read. Patients often made strong statements about me without much evidence. Again, it was largely complimentary so I let things be.

Over time, it dawned on me that virtually every patient was looking me up. I went back to the Internet and tried to picture what I would think if I were a patient looking me up. I realized I was passively being defined, as opposed to actively defining my own image -- and the method of others defining me was often incomplete and arbitrary.

I decided to launch my own website so I could define my online image. I wanted to project what I believe in, and how I practice medicine so that patients who research me can more accurately see if my philosophy truly resonates with theirs.

Of course, it's not so easy. Just putting something out there doesn't assure that it will be what patients find when they search. More importantly, it got me thinking about the doctor/patient relationship. It is clear that patients want to connect with their doctors. Doctors, however, seem more ambivalent about making such a connection. To some doctors, it is as if forming a connection will somehow undermine the traditional relationship which is best kept as formal, paternalistic, and standoffish. We are running our practices the same way they were run 30 years ago. This is a terrible mistake.

I believe I can gain more by giving, learn more by listening, and influence more by connecting.

1. Doctors should focus on connecting with patients.
The world has changed. Most other businesses have changed. Every physician should have his or her own website which patients can easily access. If the physician boldly puts his or her personality and philosophy out there for scrutiny, there will be some who like what they see and some who don't, but the patients who make appointments and ultimately come in to the office will have more productive experiences.

2. Doctors should provide content.
Consumers want content when they do research. Consumers of health care are no different. The best way to advertise is not to yell about how great you are, but simply, to teach. Patients are attracted to content, and particularly, to how the content is presented. You don't have to tell consumers of your value, when you can provide them with content of value.

3. Doctors should embrace social media.
Most doctors pride themselves in getting patients from word-of-mouth. This has always been considered the most desirable method of growing a practice. But word-of-mouth is not as useful as it has been traditionally considered.

Think about researching a restaurant. What is more likely to draw you to a particular restaurant: hearing from several arbitrary people that it is great or not only hearing from these several arbitrary people, but hearing from some specific people who have a track record of making good suggestions about restaurants and also having access to the menu, the restaurant's philosophy on cleanliness and the rigor with which food is selected and procured?

Social media is more than simple word-of-mouth. It enables patients to access meaningful opinions, and then make informed decisions about doctors' practices. Social media gives physicians the opportunity to help empower patients. If a doctor does not embrace this burgeoning technology, his or her prospective patients will end up elsewhere.

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Keeping Employees Happy During System Implementations

Keeping Employees Happy During System Implementations | Online Reputation Management for Doctors |

Implementing a new patient management system is a huge investment in terms of time and dollars. It can also be very stressful on all involved. Changes in the healthcare climate often contribute to an organization’s decision to implement a new system in an effort to meet current and future healthcare mandates. New systems often offer technology that is more technically advanced and robust, causing concerns among employees about their ability to learn new functions and workflows in a relatively short amount of time. These concerns often result in real and imagined barriers to staff adapting to the change. So how do you get employee buy-in during a system implementation?

Foster Employee Involvement

In any organization, change is better received when not strictly mandated downward. It is important to create an environment that allows employees to feel that they are a part of the decision making process. The transition to a new system can be successful when opportunities are developed for active engagement among the management and staff. Several steps should be taken to encourage participation and keep employees engaged during this time of significant change, while still keeping the timeline and projected costs in check. We recommend the following:

  • Create a workgroup to categorize, review and understand current state policies and procedures.
  • Create a repository for the existing policies and procedures. Review these policies often throughout the system development and implementation phases. The goal should be to identify gaps and opportunities between current state and future state.
  • Be ready to share. Hold monthly “town hall” meetings during the build phase to provide staff with glimpses of the new system and provide information about next steps, answer questions and concerns.
  • Develop training that is role-based and centered on policy and procedure workflows. It is not uncommon for end users to be highly stressed at the thought of learning and adapting to a new system. Providing training specified on workflows creates a real world environment, allowing users to practice scenarios that are relevant to their job role and improving their comfort level.

Cultivate System Champions

In order to be successful, it is imperative that there is involvement from different employee groups that utilize the system, both non-clinical and clinical. Often, organizations approach a project of this magnitude with a rigid project management stance in order to keep the project timeline and budget intact. Not enough time is spent on gathering “buy in” and system acceptance to reduce the anxiety of the staff that is most impacted. I Involving staff early and often can pay huge dividends in terms of buy-in, satisfaction and timeline. We recommend the following strategies:

  • Map current workflows from start to finish with the aid of designated staff who utilize the functionality
  • Ask staff to list opportunities for improvement and identify workflows that are currently working well.
  • Review workflows for redundancy and encourage new ways of looking at an old issue or process. There are always different ways to obtain the same result. Avoid the all too common idea of, “we’ve always done it this way.”
  • Create access to the new system that is based on user role, testing and training by role. This way, people can learn in an environment that mirrors production. This will greatly decrease potential end user frustration.
  • Choose staff from each modalitythat can act as “super users” who are willing and ready to:
    • Disseminate positive information to his/her department
    • Bring questions and concerns back to implementation team
    • Help develop/update policies and procedures based on new system workflows and best practices
    • Help users understand the new system functionality by utilizing the approved workflows defined at the beginning of the project

Involving staff is important, not only to gain insight into job functions and activities but also to create system champions excited for change.

Participation, Not Delegation

System implementations can be both exciting and exasperating at the same time. Involving staff in a strategic way will improve the overall end result. Allowing staff to have input will ensure that all end user needs have been identified, reviewed, streamlined and implemented if appropriate. Staff buy-in will be heightened if employees feel they are involved. Allow for input, understand current processes, and track employee feedback regarding both current pain points and needs when developing a system implementation strategy.

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Physician guidelines for Googling patients need revision

Physician guidelines for Googling patients need revision | Online Reputation Management for Doctors |

With the Internet and social media becoming woven into the modern medical practice, Penn State College of Medicine researchers contend that professional medical societies must update or amend their Internet guidelines to address when it is ethical to "Google" a patient.

"As time goes on, Googling patients is going to become more and more common, especially with doctors who grew up with the Internet," saysMaria J. Baker, associate professor of medicine.

Baker has dealt with the question first hand in her role as a genetic counselor and medical geneticist. In a case that inspired her recent paper in the Journal of General Internal Medicine, a patient consulted her regarding prophylactic mastectomies. The patient's family history of cancer could not be verified and then a pathology report revealed that a melanoma the patient listed had actually been a non-cancerous, shape-changing mole.

Turning to the Internet, Baker found evidence of the patient capitalizing on being a cancer victim for a cancer she did not have.

The question, Baker says, is in what circumstances is it appropriate for a doctor to research a patient using online search engines?

"Googling a patient can undermine the trust between a patient and his or her provider, but in some cases it might be ethically justified," Baker says. "Healthcare providers need guidance on when they should do it and how they should deal with what they learn."

With regard to future guidelines, Baker and her co-authors suggest 10 situations that may justify patient-targeted Googling:

  • Duty to re-contact/warn patient of possible harm
  • Evidence of doctor shopping -- visiting different doctors until a desired outcome is acquired.
  • Evasive responses to logical clinical questions
  • Claims in a patient's personal or family history that seem improbable
  • Discrepancies between a patient's verbal history and clinical documentation
  • Levels of urgency/aggressiveness are not justified by clinical assessment
  • Receipt of discrediting information from other reliable health professionals that calls the patient's story into question
  • Inconsistent statements by the patient, or between a patient and their family members
  • Suspicions regarding physical and/or substance abuse
  • Concerns regarding suicide risk

"Under certain circumstances -- when carefully thought out -- it may be appropriate to Google a patient," said Baker. "We're hoping that by offering scenarios that raise important ethical questions about the use of search engine technology, we can initiate a conversation that results in the eventual development of professional guidelines. What are the justifications? How is this information that you might potentially learn going to impact the patient-provider relationship and how are you going to document the information about the patient that you might learn?"

Formal professional guidelines could help healthcare providers navigate this current 'Google blind spot,' " said Baker. While professional medical groups such as the American Medical Association and the Federation of State Medical Boards provide general guidance on appropriate Internet and social media use, they have yet to address patient-targeted Web searches.

"Any professional medical society's policy statements on the use of the Internet and social media -- which they should all have -- should undergo revision to help provide guidance to their various health care providers," Baker says.

Co-authors on this paper are Daniel R. George, assistant professor of medical humanities, and Gordon L. Kauffman, professor and vice chair of surgery, both at Penn State College of Medicine.

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Five Keys to Help Physicians Connect via Social Media

Five Keys to Help Physicians Connect via Social Media | Online Reputation Management for Doctors |

So physicians, you've finally come to the realization that you need to be present in the digital world in order to be found. According to Pew Research, 80 percent of us go online first to answer our questions about health — before we call our family or friends or doctor. And you have updated your ancient website with a fancy new format that can be viewed in a browser, but also on mobile devices … right?

But you still don't have visitors to your website. And those people who do visit don't make appointments to see you at your practice. What are you doing wrong?

Too many of us use our websites as if they are traditional marketing materials: brochures, direct mail, etc. We place flashy descriptions on our home page about our services; we include our impressive credentials; maybe we even post on Facebook or send out Tweets about how great our practice is. And if we're really ambitious, we license some articles from Mayo or other sources, include some stock photos to make it pretty, and add those to our "blog" or digital newsletter.

But that's all about you.

In the digital world, it's not about you, it's about them. It's about your patients and your prospective patients. Frankly, they don't much care about where you received your degrees, or about your website's flashy features. They're looking for help answering their health questions. They're looking for evidence of expertise and authority in their area of need. They're looking for evidence of a caring physician who will listen to them. They are looking for human connection.

So how, exactly, do you achieve these goals? May I humbly suggest five keys to online content that connects with patients?

1. Understand your patients. You can't deliver if you don't know what they want. How to know? Easy: Listen. Keep a small notebook in your pocket during clinic. Record frequently asked questions (FAQs). Keep a similar record of patient FAQs at the receptionist's desk. Have these patient FAQs collated weekly to determine important themes. Then you can create content that people are looking for.

2. Serve them. A great content brand passionately serves its community's needs. Your content must be interesting and informative, but most of all, helpful. Above all else, great content helps solve your community's health problems.

3. Be consistent. Provide online content with a consistent tone, and consistent delivery. All of your marketing materials should deliver the same vision, image, look, and feel — the same message — to your community. Keep to a schedule: If you produce a quarterly newsletter, don't produce it weekly for a while, then every six months for a while. Be consistent.

4. Demonstrate expertise. By delivering helpful and accurate content, your practice becomes an authority. Your community will see you as their go-to source for any information related to your specialty. They will return. And when they need to make an appointment, they will call your practice.

5. Provide unique, quality content. Maintain a high standard, and don't stoop to licensed articles from other sources. Those will appear on many websites and dilute your authority. Your site may even be penalized for "duplicate content" by search engines. Better to produce less quantity and greater quality.

Russell Faust, MD, PhD is the CEO and managing partner of Windriven Group, a firm that

- See more at:

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A Physician's Role in Team-Based Patient Care

A Physician's Role in Team-Based Patient Care | Online Reputation Management for Doctors |

With Medicare-eligible citizens now representing the fastest-growing segment of the American population, it is more important than ever to find fresh approaches and new models of care to effectively manage the health and well-being of this group. Physicians, hospitals, and health plans need to find ways to work together if they are to provide patients with a higher quality of life and better care coordination while lowering overall healthcare costs. This is particularly true as it applies to low-income seniors, dual eligibles, and others with complex medical and social needs.

One tactic that is proving to be successful in this area is a high-intensity care-team approach outside of the hospital setting. Such an approach goes well beyond traditional care coordination and is consistent with a recent Avalere Health study, which reported that to be successful in today's environment, health plans and physicians need to not only focus on treating a person's medical condition but must also have strategies in place for managing a broad array of care needs across multiple settings.

For primary-care physicians, participation in a care-team program can ease the burden associated with the management of complex-care patients. It also provides a way to better manage the cost of these patients by optimizing their health and functional status, decreasing excess healthcare use, minimizing emergency department visits and other hospital utilization (including readmissions), and preventing long-term nursing home placement. 

Central to an effective care-team program is a support team overseen by a nurse practitioner and a social worker that work in concert with the primary-care physician to comprehensively address a patient's health conditions and achieve a patient's goal from the comfort of their own home. To be successful it is imperative that the team provides patients with healthcare education; medication management; and coordination of care between specialty physicians, the emergency department, hospitals, and a broad array of community support services.

In addition to better serving patients from a clinical and social standpoint, there are strategic reasons for primary-care physicians to consider programs such as these. For those physicians who participate in an accountable care organization (Medicare and/or commercial), take capitated risk, or serve a significant Medicare population (and are at risk for adverse events such as readmission and other penalties), this type of coordination can be a significant element in the move from fee-for-service to value-based pricing while generating cash flow and cost savings.

It is no wonder then that the Avalere study said that enrolling members into an effective care-transition or care-coordination program "can help … reduce their members' healthcare utilization and subsequently their spending." In a model presented in the study, Geriatric Resources for Assessment and Care of Elders (GRACE) Team Care™  from Indiana University Medical Center produced annual savings for high-risk members of nearly $4,300 while producing a ROI for the health plan of 95 percent per year.

Physicians looking to participate in a care-team approach outside of the hospital should be sure that their program includes:

• In-home assessment and care management by a team of experts.

• Specific protocols to manage common geriatric conditions.

• Integrated EHR documentation.

• Web-based care management tracking.

• Integrated pharmacy, mental health, hospital, home health, and community-based services.

• Individualized care planning and implementation of a care plan consistent with the participant's goals.

• Frequent inter-professional team conferences.

• Nurse practitioner and social worker meetings with the primary-care physician.

• Ongoing care management and caregiver support.

• Protocols to ensure continuity and coordination of care including smooth transitions from one point on the healthcare continuum to another.

Older patients with chronic conditions and functional limitations require more medical services and social support than do their less complex or younger counterparts. And beyond their physical healthcare challenges, these patients often must deal with a host of socioeconomic stressors including low health literacy, limited access, fragmented healthcare, and poor communication and coordination of care.

The combination of all of these factors makes it imperative that physicians, hospitals, and health plans continue to look for even better ways to serve these citizens in need. By moving the traditional concept of care coordination to a new level, the entire healthcare system can be more efficient, more patient-centric and more responsive to improving the entire patient experience.

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Flawed Regulations Will Stand if Physicians Sit Out

Flawed Regulations Will Stand if Physicians Sit Out | Online Reputation Management for Doctors |

In my recent article, "Well-Intentioned Physician Mandates Lack Success,"  I commented on the dismal track record of grand schemes and the accumulating evidence of their ineffectiveness. Schemers have a goal: public or covert, selfish or aimed at the greater good. The grand schemes that I cited, and many others, are based on assumptions about what will, must, or ought to happen as well as an assumption that the scheme itself will cause no undesirable side effects (aka unintended consequences). I suggested that now, with Republicans in control of Congress, and knowing their professed dislike of regulation, they should take aim at those schemes for which there is no evidence.

"Take aim" raises questions: Does evidence mean anything to the Republicans? Do they view and think about evidence the way scientists do? After all, a deep understanding of science is not a prerequisite for election to Congress. Legislators are basically ordinary folks. Among them are climate change deniers, evolution deniers, vaccine deniers, women's' rights deniers and deniers of who knows what else; all subjects where others find convincing evidence that can guide their decisions. Some legislators simply dislike regulation on principle, not whether a regulation has merit.

Those who think evidence counts should be skeptical of, and opposed to, grand schemes for which there is no evidence. Those who dislike regulation in any form as a matter of doctrine should be opposed to grand schemes that entail regulation. Both camps should find support among the deniers, for they dislike anything that conflicts with their beliefs.

How is it that groups composed of people who ought to oppose grand schemes for one reason or another, end up adopting so many of them? Something must outweigh both lack of evidence and doctrine.

Perhaps those favoring the scheme stand to personally gain or lose.

There may be (secret) obligations to financial supporters.

A legislator or functionary may not care about a particular scheme but sees a chance to use it as a bargaining chip as they attempt to line up support for their own grand scheme.

If only people would readily alter their beliefs when presented with evidence.

With this as background, David Allison asked, in a comment, "So what are physicians going to do about it?" His suggestions are: join a medical association (just not the AMA, he has a favorite), boycott maintenance of certification and other regulations that intrude into issues of professional judgment, and conduct and seek recognition from an alternate accrediting body (again, he has a favorite).

I don't disagree with any of these suggestions, but rather than asking what physicians "might" do, let's ask: What "are" they doing? According to a recent article in Medscape, what they are doing is getting burned out. Regulation decreases the control that physicians have over their practice and loss of control contributes to burnout. Burnout jeopardizes the goals of healthcare reform.

I find two messages in Dr. Allison's comments. They are:

• Get organized.

•Stand up for and act on your beliefs.

Physicians could combat loss of control by getting organized, and that does not mean joining the AMA or the Association of American Physicians and Surgeons (AAPS). It means doing the one thing that most swear they would never do: forming or joining a union and being prepared to strike.

New York Times columnist and professor of economics Paul Krugman has this to say about unions: "Once upon a time ... America ... had a strong union movement ... Unions ... provided an important counterbalance to the political influence of corporations and the economic elite...," and, I would add, legislative and regulatory abuses committed by governmental and quasi-governmental bodies.

As the pressure on healthcare organizations increases, the collegial environment that has led employed physicians to resist unionizing can be expected to deteriorate. The push to industrialize medicine will force employed physicians into the role of factory workers; they will need to organize if they hope to retain their control of patient care.

The federal government, through its control of Medicare and Medicaid funding controls, for all intents and purposes, physicians' working conditions and remuneration. This makes the government the de facto employer, whether they see Medicare/Medicaid patients or not, since the regulations affect all physicians. Independent practitioners will need to organize if they hope to counteract this trend.

Only if physicians vote with their feet and wallets and the patients are lining up at government's doors for care, will the message hit home that regulation has run amok. Until then, political aspirations and money from special interests will trump complaints from individuals, the AMA, or the AAPS. There are two choices: accept whatever is imposed on you or act decisively to oppose it. If physicians don't care enough to act decisively, the regulations will stand. Lack of effective resistance will be interpreted as a vote in favor of the regulations because, after all, physicians agreed (went along) with them. If individual physicians continue to remain aloof, the profession will collectively deserve whatever happens to it.

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The Fundamental Challenge of Building a Healthcare-Provider Focused Startup

The Fundamental Challenge of Building a Healthcare-Provider Focused Startup | Online Reputation Management for Doctors |

Over the past few years, the government imposed copious regulations on healthcare providers, most of which are supposed to reduce costs, improve access to care, and consumerize the patient experience. Prior to 2009, the federal government was far less involved in driving the national healthcare agenda, and thus provider IT budgets, innovation, and research and development agendas among healthcare IT vendors.

This is, in theory (and according to the government), a good idea. Prior to the introduction of the HITECH act in 2009, IT adoption in healthcare was abysmal. The government has most certainly succeeded in driving IT adoption in the name of the triple aim. But this has two key side effects that directly impact the rate at which innovation can be introduced into the healthcare provider community.

The first side effect of government-driven innovation is that all of the vendors are building the exact same features and functions to adhere to the government requirements. This is the exact antithesis of capitalism, which is designed to allow companies to innovate on their own terms; right now, every healthcare IT vendor is innovating on the government’s terms. This is massively inefficient at a macroeconomic level, and stifles experimentation and innovation, which is ultimately bad for providers and patients.

But the second side effect is actually much more nuanced and profound. Because the federal government is driving an aggressive health IT adoption schedule, healthcare providers aren’t experimenting as much as they otherwise would. Today, the greatest bottleneck to providers embarking on a new project is not money, brain power, or infrastructure. Rather, providers are limited in their ability to adopt new technologies by their bandwidth to absorb change. It is simply not possible to undertake more than a handful of initiatives at one time; management can’t coordinate the projects, IT can’t prepare the infrastructure, and the staff can’t adjust workflows or attend training rapidly enough while caring for patients.

As the government drives change, they are literally eating up providers’ ability to innovate on any terms other than the government’s. Prominent CIOs like John Halamka from BIDMC have articulated the challenge of keeping up with government mandates, and the need to actually set aside resources to innovate outside of government mandates.

Thus is the problem with health IT entrepreneurship today. Solving painful economic or patient-safety problems is simply not top of mind for CIOs, even if these initiatives broadly align with accountable care models. They are focused on what the government has told them to focus on, and not much else. Obviously, existing healthcare IT vendors are tackling the government mandates; it’s unlikely an under-capitalized startup without brand recognition can beat the legacy vendors when the basis of competition is so clear: do what the government tells you. Startups thrive when they can asymmetrically compete with legacy incumbents.

Google beat Microsoft by recognizing search was more important than the operating system; Apple beat Microsoft by recognizing mobile was more important than the desktop; SalesForce beat Oracle and SAP because they recognized the benefits of the cloud over on-premise deployments; Voalte is challenging Vocera because they recognized the power of the smartphone long before Vocera did. There are countless examples in and out of healthcare. Startups win when they compete on new, asymmetric terms. Startups never win by going head to head with the incumbent.

We are in an era of change in healthcare. It’s obvious that risk based models will become the dominant care delivery model, and this is creating enormous opportunity for startups to enter the space. Unfortunately, the government is largely dictating the scope and themes of risk-based care delivery, which is many ways actually stifling innovation.

Thus is the problem for health IT entrepreneurship today. Despite all of the ongoing change in healthcare, it’s actually harder than ever before to change healthcare delivery things as a startup. There is simply not enough attention of bandwidth to go around. When CIOs have strict project schedules that stretch out 18 months, how can startups break in? Startups can’t survive 18 month cycles.

Thus the is paradox of innovation: the more of it you’re told to innovate, the less you can actually innovate.

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Pay doctors and nurses for the time they spend charting

I have a unique perspective as a physician. Having traveled to many hospitals in the past two years, working as a locums emergency physician, I can comment on a variety of issues with a reasonable amount of experience.

One of those issues is EMR, or electronic medical records. I have spent plenty of time writing about this in the past, and I will continue to do so. Because all across the country the same problems, the same frustrations are evident. And the institutional lack of concern is well-entrenched and well understood by everyone affected.Whether working in an academic teaching/trauma center or a small community department, one theme emerges.

EMR is so inefficient, and patient volumes and acuity so high, that charting isn’t done real-time. Unless it is accomplished with scribes, or by dictation, doctors stay after their shifts, or chart from home, or come in on their days off in order to complete their documentation. Needless to say, this is unlikely to create the best possible chart. Not only is this true, I have watched as nurses sat for one to two hours after their busy ED shifts, catching up on the ever increasing documentation requirements in their EMR systems.

Weary from a long day or long night, they sift through notes and charts, orders and code blue records, trying to reassemble some vague estimation of what happened in the chaos of their 8 or 12 hours on shift, when they were expected to function simultaneously as life-savers and data-entry clerks. Further, the nurses are frequently tasked with entering specific charges for billing as well. It all constitutes an unholy combination for any clinician.

Dear friends, colleagues, Romans, countrymen; dear politicians and administrators, programmers and thought leaders, this is unacceptable. Entirely unacceptable. If the charting system is so poorly designed, and so counter-intuitive to the work we do that it can’t be used real-time, then it should be replaced with something far better. And if it isn’t replaced, then everyone needs a scribe to chart for him or her, or we should allow dictation all around. And if none of that is acceptable, if even those reasonable options are rejected, then every nurse and every physician who stays after shift should be paid their regular hourly rate for time spent charting.

The thing is, these systems are generally not the idea of the clinicians who are saddled with them. They are imposed by corporations and administrators who believe the salesmen and hope to capture more billing and data. They are imposed by the meaningful use regulations of the federal government. But as a rule, when we clinicians say a system is bad, or won’t work for us, we are patted on the head and dismissed.

“It’s fine, it’s an industry standard. You can learn to use it. You don’t want to be a problem doctor do you?”

One of my friends is in a group shopping for new systems. When his partner asked to take the potential EMR for a test drive, the salesman said, “Sure, as soon as you sign the contract.” Pathetic. I call on everyone involved in implementation of EMR to find the simplest, most physician and nurse friendly systems possible. And to do it by asking and involving the end user. By which I mean those who provide patient care, not those who cull through it for billing and documentation. Some people chart more slowly than others. That can be an individual issue.

But when a system consistently causes good, efficient doctors, nurses, NPs and PAs to stay long past their shifts, or come in on days off, or chart from their homes (which should be places of recuperation and rest), then we need to give them something back. Equally toxic, some physicians and nurses can only get out in time by charting in a manner that results in a pages long list of checkboxes, rather than a descriptive, informative story.

America’s emergency departments are overwhelmed with passwords, required fields, clicks and key strokes, at the same time as they are overwhelmed with the sick and dying. They are the last safety net for the uninsured and underinsured. They are the point of rescue for the poor, the brutalized, the traumatized, the addicted, the psychotic. Day in and day out, nurses and physicians in emergency departments, indeed all over the modern hospital, do their best against sometimes overwhelming odds. In the midst of this, poor charting systems constitute a crushing blow.

Pay the staff for their time spent charting, or fix the systems. Or both. But something has to give.

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ICD-10 Testing Tips for Small Physician Practices

ICD-10 Testing Tips for Small Physician Practices | Online Reputation Management for Doctors |

Small physician practices of one to five doctors may find ICD-10 testing more challenging than bigger medical facilities. Luckily, the Workgroup for Electronic Data Interchange (WEDI) released a white paper last week that offers a comprehensive plan for small physician practices looking to begin ICD-10 testing.

The publication targets external testing with payers. Starting in October, payers will incorporate ICD-10 codes in payment decisions and coverage. By performing ICD-10 testing, medical offices will be ensuring that their claims will be appropriately processed once the new coding system is in place across the country.2014-10-02-WEDI

The white paper goes into detail about some of the risks that ICD-10 testing will minimize. The risks include:

1) Claim denials and claim delays associated with ICD-10 coding errors

2) Cash flow disruption

3) EHR and other software applications’ inability to produce ICD-10 claims

Small physician practices may be experiencing a number of challenges with regard to ICD-10 testing such as few testing opportunities with payers or clearinghouses due to limited number of testing spots, inadequate ICD-10 training available for staff, and scarce provider resources available on ICD-10 testing.

To overcome some of these common challenges, the white paper covers key steps a small physician practice will need to take. First, it is important to speak with your EHR vendor and confirm that all software products and applications are ICD-10 compliant.

Then, identify the payers that process the highest percentage of your claims and be sure to test ICD-10 readiness with your top payers. Work with your clearinghouse or billing service to see how they can assist with ICD-10 testing.

Be aware that some payers are creating web-based, self-service testing opportunities for small medical practices. After speaking with your clearinghouse, the next step to take is to seek more resources through payer ICD-10 websites and provider newsletters.

Confirm that what you need to test aligns with what your payer is testing so that every base is covered. While there is still time, be sure to contact Medicare Administrative Contractors (MACs) and the Centers for Medicare & Medicaid Services (CMS) to register for ICD-10 testing during the remaining testing weeks.

For those wondering the best time to test, be sure to set aside plenty of time before the October 1 implementation date to complete your ICD-10 testing. Before you begin testing, determine if your team and needed resources are ready. Additionally, it’s vital to confirm that all payers and other partners are also ready to start ICD-10 testing. Contact clearinghouses and billing services to find out when their testing sessions take place.

CMS, for instance, offers end-to-end testing on April 27 through May 1 and July 20 through July 24. For the July testing session, providers have until March 13 to sign up. Creating a timeline for your ICD-10 preparations would also be a worthy goal.

Once you’re ready to begin ICD-10 testing, follow the instructions received from the payer or billing service end. When incorporating the new codes, it is important to pay attention to qualifiers, headers, and other key format items.

After you have completed ICD-10 testing, be sure to review the results and compare the actual data to predicted information. Analyze both the successes and failures of your submissions. Additionally, work with your payers to understand any errors that may have occurred and develop strategies to prevent the issues from taking place in the near future.

If you are a small physician practice, follow these ICD-10 testing tips to minimize any risks after the implementation deadline.

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5 Medical Device Tips for Maximizing Your IP (Intellectual Property) Portfolio

5 Medical Device Tips for Maximizing Your IP (Intellectual Property) Portfolio | Online Reputation Management for Doctors |

The world of medical devices is really fascinating. It’s a world that I think many hospitals know about and many more hospitals are starting to learn about as they grow some medical device innovations in house. With that in mind, I was really intrigued by a list I was emailed of 5 medical device IP tips from Frank Becking of Panthera MedTech.

  1. Control access to sensitive information: Don’t talk publicly about your idea before pursuing the necessary protection. Even with confidentiality agreements in place, until you have filed for a patent any disclosure risks your potential rights and future prospects.
  2. Make sure your company owns its intellectual property: This might seem obvious but it is easy to overlook key steps, like putting in place and enforcing agreements that ensure that work produced by employees and independent contractors becomes the property of the company. And making sure that those same contractors or employees do not have pre-existing, conflicting obligations to other parties. Work with legal counsel to ensure state law compliance of IP-related agreements, as some states restrict assignment and other scope.
  3. Don’t neglect country-by-country protection: IP protection opportunities differ around the globe. Select state-side IP counsel that has existing relationships with expert foreign counsel who can advise on how best to navigate international waters.
  4. Actively avoid third-party IP entanglement: Too often, corporate executives focus on the patentability of their own IP. Understanding and tracking 3rd party patents and the progress of their pending claims (i.e., handling questions of Freedom to Operate) often has a greater effect on corporate valuation. A startup with technology that infringes upon another company’s IP can be dead in the water. Design-around is very often an option, but usually represents a costly and time-consuming exercise that should be guided by experienced IP counsel.
  5. Formulate an IP enforcement strategy: It is important to monitor the market to ensure that your IP rights are not being infringed. However, the bigger question is often what a company should be done if it detects infringement. Venture-capital funded startups are notoriously averse to engaging in litigation. Sending a cease-and-desist letter can open the door for the noticed party taking the fight to you. Again, working closely with experienced IP counsel is key to understanding and pursuing your enforcement goals.

How many of your hospitals are dealing with these types of issues?

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Steering the Healthcare Ship: A Call to the Logical, Not the Loud

Steering the Healthcare Ship: A Call to the Logical, Not the Loud | Online Reputation Management for Doctors |

The other day I was on the subway coming into our New York City office when two people, presumably a couple, were really going at it verbally. For at least five minutes, insult after insult, swear after swear, was screamed by the woman, who in this particular instance, apparently wanted the entire train—and perhaps the entire city—to hear her gripes. Thankfully, both of these people got off the train at the next stop, putting everyone’s ears to ease.  While I’ll never know (or care) who was more at fault or who was right in this argument, I figured that if a woman is going to scream this loud at 8 a.m. in a crowded subway car, most likely she’s a little kooky. But for the rest of us who had to hear this delightful conversation, it will indeed be the words of the loud woman that we will remember most.

This little anecdote is a reminder that those who shout loudest aren’t always in the right just because their voice is heard most. We see this in all aspects of life—on TV, radio, in person, on Twitter, everywhere—people think that screaming, moaning, and speaking in hyperbole means that their points count more than others’.  This applies to health IT, too. The industry is going through a massive period of change, one where people will have all different opinions about said change. But it’s important to remember one thing—the opinions that you hear might not always be the most accurate ones.

Last week at the iHT2 Health IT Summit in Miami, Fla. (the Institute for Health Technology Transformation, iHT2, is a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC), I had a conversation with the CMIO of a Florida health system about this very topic. He asked me about the media’s stance on everything that is happening in healthcare, particularly related to the shifting landscape from a volume-based system to a value-based one. He further asked me how the media can help tell the voices of the people in the middle, rather than the ones on the extreme ends. These were interesting questions, and to be honest, I didn’t have the best answers for him at the time. We can only report on what we hear, right? Is it our fault that the reasonable, patient people aren’t the loudest ones? But after I left Miami, I thought more about it, and realized that this CMIO was right. Healthcare is no different than anything else in this regard—the extremists might very well be scaring the ones in the middle.

Listen, it’s really easy to say ICD-10 is useless, or we should call it quits on meaningful use, or that EHRs are a waste of money, or that patient engagement is unrealistic, or that true interoperability will never happen.  The people that have these viewpoints are the ones that get heard most frequently. But are they right?

It was fascinating to see what the folks at the Cleveland Clinic are doing with technology. At the iHT2 Miami Summit, C. Martin Harris, M.D., Cleveland Clinic’s CIO, delivered a keynote presentation about how his organization has adapted to the shift by establishing four key principles: quality, safety, care coordination, and cost effectiveness.  To help meet these goals, Cleveland Clinic became an early adopter of EHR technology, with the goal to create a single tool so all of the organization's caregivers could use it in caring for the patient. The EHR is at the core of everything the health system wants to do as we move forward in the new healthcare, Harris proclaimed. I can go on and on about all of the tools the Cleveland Clinic is using to better care for their patients and get them more engaged in their health, but that’s what this article is for. Granted, this is one health system that has significant resources and ability to make these types of changes, but it is an example of an early adopter that’s having real success. Dr. Harris’ keynote wasn’t flashy, sexy, or loud, but you know what it was? Efficient, forthcoming, and full of results.

Speaking of results, many people have made the point that the bottom line is not what we thought it would be when we began on this path years ago. And to a degree, they’re right; it has taken longer than anyone thought. Plenty more needs to be done, and much more alignment is needed. But that doesn’t mean that it’s time to give up. The CMIO I spoke with in Florida compared this shift to a massive ship that has been moving one way for its entire voyage, but suddenly needs to be steered in another direction.  This “turn” the ship will make cannot happen overnight, and what’s more, it will need serious push, force, and instruction to get it going another way. The healthcare industry is no different, the CMIO told me. It will take years to make this change, and more than even time, it will take a commitment. Commitment from providers, payers, patients, and the feds. Right now, we don’t have that, and one reason for that might be because the reasonable people in the middle might be getting overtaken by the extremists on the ends. That has to change.

I think health IT conferences like the one I just went to, in addition to the gigantic HIMSS one coming up of course, provide a way for the industry to hear the voices of the logical, rather than just the loud. These events are full of CIOs, clinical informaticists, and other healthcare IT leaders who are trying to make it work in the new healthcare, but need direction. This change undoubtedly takes a major cultural shift, one that I wouldn’t expect the extremists to understand. So call me naïve, but I just so happen to think that if all of these people come together and provide this direction, then perhaps this healthcare ship will finally turn the way it was intended to.

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The Reason Many Medical Practice Change Initiatives Fail

The Reason Many Medical Practice Change Initiatives Fail | Online Reputation Management for Doctors |

Good is rarely good enough, and opportunities for improvement are never lacking. Unfortunately, the success rate of major change initiatives in medical practices is often low due to poor management of the change. 

Physician leaders and practice managers should expect and accept disruption and resistance to change, and never lose sight of the fact that costs are high when change efforts go wrong. 

The consequences of poorly executed change are not only financial costs, but also lost opportunity, wasted resources, confusion, and diminished morale. 

Here are three major areas to focus on to help with your change management efforts.

Clarify direction
As the saying goes, “culture is everything.”  To effectively manage change, you must consider your practice culture, and thus clarify how the change relates to your practice culture, vision, and goals.

Communication is paramount when trying to raise the level of understanding of why the change is taking place. Employees should be told why the change is taking place, what the change will mean for them, when the change will be happening, how the change will be carried out, what support will be available to help them adjust to the change, and what will be expected of employees as a result of the change. 

Over-communicate your goals, direction, and expectations.  It's not enough to send out an e-mail addressing those points. Communication should be regular and should continue over an extended period of time.

Invite and acknowledge concerns
Make change a part of your business and an expectation among staff and providers.  Many members of your practice are innovative and eager to contribute their insights and suggestions for improvement.  Treat them as a natural part of the process and address resistance by asking for input. 

Work with all staff to measure “real” vs. “perceived” disruption.  The path of rolling out change is immeasurably smoother if these people are tapped early for input on issues that will affect their jobs. 

The goal is to quickly get employees through the denial and resistance stages and on to the commitment phase where you get the buy-in from staff.

Develop commitment
Work on developing commitment from the staff and avoid demanding compliance.  People respond to calls to action that engage their hearts as well as their minds, making them feel as if they’re part of something consequential, so make the rational and emotional case for change together. 

Their full-hearted engagement can smooth the way for complex change initiatives, whereas their resistance will make implementation an ongoing challenge.  Address any reservations and give some consideration to possibly rewarding initiative.  You must either build commitment or prepare for the consequences.

Medical practices must constantly change in order to survive in today’s competitive healthcare arena.  Practices should never settle for something that is considered completed; all things can improve with change. 

Managing change in an already busy practice environment, however, can be challenging and you may want to consider bringing someone in to help structure the rollout of a project and guide you through key change initiative milestones.  When employees who have endured real upheaval and put in significant extra hours for an initiative that was announced with great fanfare see it simply fizzle out, cynicism sets in.

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Four Ways to Reduce Your Malpractice Risks

Four Ways to Reduce Your Malpractice Risks | Online Reputation Management for Doctors |

As a physician, the fear of a malpractice lawsuit will always be present. But knowing you are doing all you can to prevent one from occurring can help set your mind at ease. Providing excellent clinical care can, of course, reduce the likelihood of an error that leads to a lawsuit, but the clinical side is not the only area to focus on.

For more insight into the non-clinical risk-management strategies every practice and physician should follow, we asked experts to weigh in. Here are four ways you can decrease your risk of a lawsuit.


Great communication between physicians and patients can reduce malpractice risks in many ways, says Jeffrey D. Brunken, president of physician insurer MGIS. When you have a trusting rapport with patients, studies show that they are more likely to disclose all of their relevant medical information. Of course, that reduces the risk of a diagnostic error or misstep that could lead to a lawsuit

Perhaps even more important to risk management, great communication fosters a strong relationship with patients, which, also, according to several studies, reduces the likelihood a patient will sue if a problem arises, says Brunken. "Errors are always going to happen," he says. "Generally, reducing risk involves, 'How do you reduce the risk when bad things do happen?'"

Here are a few key communication strategies Brunken says physicians should employ when interacting with patients:

• Don't dismiss (or appear to dismiss) the patient's concerns.

• Listen carefully.

• Set realistic expectations.

• Provide clear answers.

"Those things are always to let the patient know, 'Hey, I'm listening to you. I'm hearing you. You can trust me. Tell me more,'" says Brunken.

Sue Larsen, president and director of education at Astute Doctor Education, Inc., which provides online education and resources specializing in physician interpersonal skills, says physicians should also be aware of, and actively avoid, four communication missteps that increase the likelihood of a lawsuit. She says avoid interactions that make the patient feel: devalued, misunderstood, deserted, or misinformed.

For tips on how to avoid each of these scenarios, see sidebar, "Interactions that Lead to Lawsuits."


Just as physicians' interactions with patients are critical, so are staff members' interactions with them, says Larsen, noting that poor customer service leads to poor patient satisfaction, which increases the likelihood of a lawsuit. "It's highly important that every interaction provides an interaction that leads to patients feeling that they are going to somewhere that is highly competent and values their contribution," she says.

Here are four ways to ensure that your staff is not putting you at risk:

1. Require excellent professional etiquette. Staff members need to be cognizant that their conversations with other staff, such as discussions about kids, TV shows, and so on, may be overheard by patients, says Robin Diamond, an attorney and registered nurse who serves as the chief patient safety officer at malpractice insurer The Doctors Company. Those conversations, especially if inappropriate, can be very off-putting to some patients.

2. Make sure staff members explain delays. Long waits, with little or no explanation, are very frustrating to patients. To reduce the frustration, staff should explain delays to patients and share regular updates, says Larsen.

3. Provide training on difficult patient encounters. Angry or demanding patients may dish out their frustration on staff, so they play a big role in whether these situations are handled appropriately. Diamond recommends holding training sessions in which staff and physicians role play difficult patient encounters so that everyone is comfortable with and knowledgeable about how to handle these situations.

4. Ask staff to serve as your eyes and ears. Front-desk staff should observe patient reactions and emotions as they are leaving your practice. If patients leave upset, staff should inform the physicians and/or managers, who can then call the patient later to check in, says Brunken. That check- in call, he says, could be the difference between a damaged patient relationship, and a more positive one.


Policies and procedures can mitigate malpractice risks in two ways: one, if properly followed, they can prevent a problem from occurring that could lead to a lawsuit; and two, if you are sued, they can reduce the likelihood the lawsuit will be successful. "Demonstrating that you followed the procedure or the policy, regardless of what it is, shows good faith," says Brunken. "I think that that applies to several areas of the practice."

Here are five policies the experts say every practice should have in place:

1. Policies related to employee expectations. In addition to encouraging staff to practice great customer service, have a policy that addresses expectations regarding staff teamwork, attitude, etiquette, and so on, says Diamond.

2. Policies related to EHR use. These policies should cover initial and ongoing staff and physician training, rules regarding the migration of paper records to electronic, and so on, says Brunken. This will help reduce the risk of an error, and, if a lawsuit does occur, this will help you demonstrate good faith, he says.

3. Policies related to scope of practice. Document scope of practice for every type of clinician within your practice, says Diamond. This documentation should include tasks each individual can perform, the type of patients they can see, and the supervision required.

4. Policies related to care protocols. These policies should include protocols for follow-up on patient tests and referrals, for calling in new prescriptions and prescription renewals, for handling appointment cancellations and no-shows, for handling patient complaints, for ensuring patient privacy, and so on, says Brunken.

5. Policies related to telephone triage. These policies should cover who can answer what type of questions and how to document those questions and answers, says Diamond, adding that telephone care missteps often crop up in malpractice cases.

A few more tips on policies and procedures:

Create "tip sheets" for staff so that they can quickly review the key elements of policies and procedures when necessary, says Diamond. Also, ask staff and physicians to review any changes or updates to policies and procedures, and require them to initial or sign that they have reviewed the changes, says Jonathan B. Stepanian, a healthcare litigation attorney at McQuaide Blasko, a Pennsylvania-based law firm.


Similar to policies and procedures, great documentation (and policies regarding it) can help reduce the risk of lawsuit. Documentation can also help support a successful defense if a patient does sue you, says Stepanian. "In a legal setting ... the record is used to prove what did or didn't happen with regard to a patient's care," he says. "So when you think about the record in that kind of context ... I think it alters your perspective on what exactly you're going to document and how much you're going to document." Stepanian says physicians should always try to document just as they would if they were teaching a first-year resident to do so.

Here are a few key documentation areas to consider:

• Documentation of informed consent. Familiarize yourself with your state's informed consent laws and adhere to them closely, says Stepanian, adding that you may want to take this a step further. "Our suggestion is that physicians [adhere to informed consent laws] not only for procedures that require informed consent, but even those procedures that don't," he says. "Tell patients about the risk of the procedure and the likely outcomes, and document that they reviewed those things."

• Documentation of consideration of prior medical history. Be sure to document that you have collected and evaluated the patient's prior medical history and prior medical visits, says Brunken. Also, note how you considered the prior medical history in the making of your diagnosis. "If you've got somebody that came in a year ago with some sort of complaint, it's important to document that you've got that in the system, and that the physician considered that during the current visit," he says.

• Documentation of patient instructions. In the patient's record, retain copies of all instructions for care that you provided, says Larsen. "... In a number of malpractice cases the doctor will say, 'Look, I know that I explained it to the patient,' but if there's no record of it, it's as if it didn't exist," she says. "It's really important that any information that is discussed with a patient is documented in the note, and also what the patient's response was to that."

Also, since the top claim in malpractice lawsuits is missed or delayed diagnosis, regularly conduct random samplings of patient charts to ensure that all tests, referrals, and so on, are followed-up on appropriately, says Diamond. If you have an EHR, you may be able to set the system to automatically send you notifications or triggers if follow-up care is not documented or completed, says Diamond. "... If the EHR is not tracking this itself, then someone has to do that and make sure that these follow-up appointments aren't falling through the cracks."


A well-trained staff can reduce your malpractice risks. Here are six training sessions every practice should provide, according to risk management experts:

What a malpractice case is, how the standard of care is proven, and how a case progresses

"Soft skills," such as those related to customer service, communication, dealing with difficult patients, and professional etiquette

Proper documentation

How to handle cross-cultural communication, language barriers, and literacy issues

All policies and procedures, and training on how noncompliance could raise malpractice risks

Risk reduction strategies based on lessons learned from malpractice cases against physicians in similar practices

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DrChrono helps small medical practices use iPads for patient records

DrChrono helps small medical practices use iPads for patient records | Online Reputation Management for Doctors |

Michael Nusimow and Daniel Kivatinos were college friends at SUNY Stony Brook on Long Island. Then Michael went to work at Bloomberg, while Daniel studied further before joining New York startups. When Michael took his father to hospitals and doctors, he was frustrated by how inefficiently patient data was handled. In some cases, paper forms needed to be filled out repeatedly. At another site, a doctor had a terminal, but he was so busy typing he hardly had time to look at the patient. Despite recent improvements to document interchange standards, sharing data between different medical institutions can be difficult given incompatible systems, complicated workflows and privacy concerns.

So Michael and Daniel decided that doctors could perform much more effectively with a web-based system. Initially, they started by automating patient communications. Their system would remind people of appointments with text and email messages. Then they added billing and interfaces to existing financial systems, learning requirements as they visited small ambulatory doctors' practices. They launched DrChrono in 2009.
According to Black Book Rankings, in 2008, only 12% of office practices had even the most basic electronic health record (EHR) systems. By 2014, 51% of office-based practices were using a fully functional EHR systems, and 82% had basic electronic medical records.

In 2010, the iPad was launched. A tablet enables a doctor to face a patient while taking notes. Also in 2010, the government was moving to make Electronic Health Record (EHR) systems more open. So DrChrono decided to build an EHR system from scratch that would work on iPads. They launched their new system in 2010 at a Health 2.0 conference in Florida. It was an exciting time. Instead of struggling to sell a web-based system, Michael and Daniel closed deals at the conference as doctors enthusiastically saw the iPad's potential.

DrChrono applied to join Y Combinator's funding program, which Michael describe as being like "a startup's coming out ball". The program requires three months intense work in Silicon Valley. So Michael thought he would come to Silicon Valley for about six months. However, the experience was so transformative, that he started raising money and hiring employees in Mountain View. The company is currently based near 101 and Rengstorff.

DrChrono focuses on making small medical practices more efficient. The system manages forms securely, submits insurance claims, schedules patients, enables email correspondence, helps doctors manage inventory, transcribes medical notes, checks for drug interactions and handles prescriptions. The doctor can share diagnostic images, from X-rays, for example on an iPad with a patient.

Patients can download an app, On Patient, to track their health and share information with their doctor. It works on both Apple or Android platforms and is only useful if your doctor has the iPad DrChrono system. On iOS8 devices it works with Apple's HealthKit, that integrates information from other health-related apps and displays them using Apple's Health app. If you have a newer iPhone or iPad you might want to check that your fitness and health apps are set to share information with Apple Health.

The company is constantly looking for technologies that can help doctors and tried offering Google Glass. The display in the glasses was useful for certain types of doctors like surgeons, who need hands free information. In general, most doctors found tablets more useful. Wearable devices to track heart rates, exercise and more will transform the doctor/patient relationship as their output is fed into doctors' systems. Michael quoted Vinod Khosla who notes on his blog that over time 80% of what a doctor does can be replaced by smart hardware, software and testing, with technology also improving a doctor's ability to perform.

The Electronic Health Records space is crowded and fragmented. DrChrono started by bootstrapping and has been extraordinarily capital efficient, compared with San Francisco's Practice Fusion, which has raised $134M from investors that include Kleiner Perkins and other big name firms. With major companies like GE, McKesson and Quest Diagnostics in the market, and many fast growing startups chasing for market share, DrChrono is racing to hire software engineers and customer relations staff so it can keep ahead of the game.

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The Internet of Things: The Reality of Connected Healthcare

The Internet of Things: The Reality of Connected Healthcare | Online Reputation Management for Doctors |

The Internet of Things, the idea that everything will someday be totally connected, is no longer a Jetson’s era fantasy. It’s becoming closer to a reality in healthcare.

We’ve discussed IoT in healthcare and what its impact could be, but what would that look like? How can healthcare be ready for this total connectivity? Most importantly, how will IoT be able to increase the efficiency of the system benefiting both practitioner and patient alike?

Increased Efficiency

Forbes discusses how IoT will be able to increase efficiency in healthcare in multiple ways. As the capabilities of devices enhance, issues can be solved remotely as well as more effectively. Further, when there are issues with devices or supplies need to be refilled, the devices will be able to sound the alarm, and the issue can be dealt with proactively. What this comes down to is that machines will be better able to regulate themselves, and this data can then continue to be used to increase efficiency of processes. Companies with connected devices are already seeing results as to how cost-effective this can be.

Effective Patient Data

How can connected devices support patients? Through data. If we think of Wearables as part of personal IoT, and the health data that Wearables can provide, we know how the data alone can benefit patients.There are many other devices that can be implemented to employ beneficial data. For example, some hospitals have begun to use smart beds, alerting nurses when patients are trying to get up, or the bed itself can help patients get up using varying pressure and support. Devices can even help patients once they leave the hospital like smart pill bottles that know when a prescription needs to be refilled or a patient hasn’t take their medicine.

Utilizing Connectivity

Greater connectivity will become apparent with these new devices, but how can these technologies be incorporated into everyday practices? Take for example Google Glass. Pierre Theodore, MD talks about the possibilities that Google Glass can provide for the doctor as opposed to the consumer. As a doctor you could use a device like Google Glass, or even simply a mobile device, to aid your practice with quick access to patient information, scheduling, and all other data connected to the cloud. This is just one way that the increased connectivity that IoT allows can be utilized.

While achieving total connectivity will require changes to the system, we are beginning to see a shift already, and the privacy and security of this data must also be prioritized. But it is clear that once devices are fully connected in the cloud, collecting data from sensors and intelligent devices, improvements can be made to healthcare. Efficiency will be increased, costs will be driven down, practitioners will have an easier time doing their job and in the end, patients will have a more valuable healthcare experience. How do you see IoT affecting healthcare?

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Want to Rank Well in Search? Get Social

Want to Rank Well in Search? Get Social | Online Reputation Management for Doctors |

There’s an old saying in the travel business that the journey is as important as the destination. The phrase speaks not just to the idea that the best trips acknowledge both aspects but also that the path you take can play a powerful role in your impressions of the overall experience.

It also speaks to the essence of medical marketing to today’s aesthetic consumer, who is most definitely on a journey. If you want your practice website to be the destination she eventually arrives at, it helps to understand the path she takes to get there.

A new study Mercury360 offers proof positive that that path runs straight through social media. Mimicking the way people research their healthcare options — 8 out of 10 start their online research with a search engine — the research found that:

  • The first link for 53% of MDs overall was a social media site
  • On average, 50% of the top three links for MDs were social media sites
  • On average, 53% of all first-page links for MDs were social media sites

In several cases, the numbers were even more compelling for aesthetic specialties: For dermatologists, for example, the top spot was taken by a social media site in 70% of searches. When the search term was switched to plastic surgery, 59% of first-page results were occupied by social sites.

That’s a lot of real estate — highly, highly visible real estate — that makes it that much harder for your practice website to get seen, a crucial stepping stone on the way to generating the clicks that hopefully help those searchers’ find their way to your door.

Social media’s influence has grown rapidly as more people rely on reviews and ratings from peers online, says Ren Bloom, CEO of Mercury360. It’s vital for physicians to have a cohesive practice strategy on social media because consumers are out there taking note of and being influenced by user generated content.

It truly is a journey and doctors who embrace its social component will be well-positioned when those patients choose their destination.

Doctor Takeaways

Claim those profiles

The days of gaming search results with sneaky SEO tactics are over. These days, generating good search results requires a comprehensive strategy that includes claiming profiles on all relevant social networks. Keep them updated (new addresses, phone numbers, etc.) as dead or outdated links can lead to poorer showings in subsequent searches.

It’s called ‘social’ for a reason

When it comes to search results, Google and its peers assign great value to ‘fresh’ content, which they interpret as being more relevant to searchers’ needs. Contributing content provides such ‘social signals’ while also exposing you to other community members with similar concerns.

Think strategically not tactically

As more people spend more time on social networks, it’s likely that social’s dominance of search results will only accelerate. And since the odds of a solo practice website overcoming that advantage are small, the better bet is to piggyback on social’s higher profile to boost your own. Honolulu plastic surgeon Larry Schlesinger, MD, FACS, for example, answers consumers’ aesthetic questions on, which provides an opportunity to appear in multiple positions — i.e., both via his own practice website and as a member of the high-ranking RealSelf community — giving web searchers even more ways to find him.

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