Boost your practice's technology savvy

December 4, 2009

Although much attention is being paid to software solutions, gadget and tool providers continue to release new equipment options.

Though most of the attention is being paid to software solutions, such as electronic health records (EHRs), device makers and technology providers continue to release a variety of new equipment, gadgets, and tools to improve practice operations or help offer more services.

In our second tech device guide for your practice, we profile eight new tools for the front office and the examination room. We feature such innovations as a reception room touch-screen tablet to keep patients occupied if you’re running behind, and a children’s vision screening tool that simply requires the young patient to watch colorful animated characters on a computer monitor. Unlike EHRs, most of these devices-ranging in price from free to more than $35,000-could start paying for themselves immediately-without waiting for a check from the government and with little or no disruption to practice operations.

FRONT OFFICE/RECEPTION AREA

InfoSlateWhat: Reception area patient education/entertainment tablet computer
By: InfoSlate Inc.
Cost: Free
Contact:www.infoslate.comHow it works: The patient picks up the touch-screen tablet PC at check-in and in the reception area can view 6,000 health education videos, browse the Web, or check personal e-mail. The tablets are paid for through banner advertising at the top and/or sides of the screen. Practices also can use the space for internal marketing.

Physician says: “[Patients] feel like it’s easy to use,” says Mark Hauptman, MD, general internist at Mission Internal Medical Group in Mission Viejo, California, who has 20 devices in the reception areas in the 50-physician, multispecialty practice. “They like the idea of making their waiting time more productive for themselves. It makes the wait time itself go by faster for them.”

Pros: It’s free. Waiting room boredom can be greatly reduced, plus practices can load patient satisfaction surveys on the device. Inappropriate Web sites are automatically filtered through the device’s Web browser.

Cons: Some practices may not want to expose patients to third-party advertising. Portable devices can get lost, although the device is equipped with LoJack, a theft deterrent system that tracks the device if it has been stolen.

You also may consider:WiSpots, (free for introductory period); Phressia pad (free).

 SignatureGemWhat: Electronic signature pad
By: Topaz Systems Inc.
Cost: $210 (1-inch by 5-inch model)
Contact:www.topazsystems.comHow it works: The patient signs the electronic pad, which is connected to the computer’s USB port, to sign-in for an appointment or to sign a form. As the patient writes, all the data associated with the signature-such as where it’s being put, what direction the pen is moving, how fast the pen is moving-are captured by the pad at 400 points per second, so it’s more than simply a photo of a signature. Security software is available to compare signatures to prove authenticity. 

Operations manager says: “It is a great communication tool that connects all the departments in our clinic,” says Kara Hufstedler, operations manager for Satellite Med, a walk-in clinic and family practice in Cookeville, Tennessee. The software used with the pad helps her two-physician office “take care of patients in order and not overlook any patients waiting to be seen.”

Pros: For practices that have gone paperless, a digital signature is more convenient than scanning in more forms, and Topaz offers free software to help your practice management system integrate with the pad. Having a digital signature on file can help detect insurance fraud more quickly and reduce errors.

Cons: As with much technical equipment, patient flow will slow down if the device malfunctions, requiring a switch back to paper.

You also may consider:ePad-ink by Internlink Electronics Inc., $319, ; Ingenico i6550 by Ingenico, $428.

Dictaphone PowerMic IIWhat: Dictation microphone
By: Nuance
Cost: $495
Contact:www.nuance.comHow it works: An updated version of the Dictaphone for the digitally inclined physician. The PowerMic II, released last year, has 12 programmable buttons and a mouse on the device, which physicians can use to navigate between fields in the EHR. If used with voice recognition software Dragon Medical, version 10, (also from Nuance), spoken notes automatically are transcribed from the PowerMic to the corresponding fields in the EHR.

Physician says: “The recognition of the speech is much better with the PowerMic than with the other microphones,” says Julian Armstrong, MD, a gastroenterologist with Gastroenterology Associates of Fort Worth, in Texas. “It has a better interface with [Dragon Medical] itself. It makes it a lot easier. The accuracy is better, and I feel like I have much better control of the application.”

Pros: For physicians hooked on dictating their notes but who want to make the transition to electronic, the PowerMic eliminates the need to type but also avoids transcription fees. The PowerMic has a noise-cancelling microphone, which eliminates background noise for cleaner transcription.

Cons: If you don’t dictate, introducing the PowerMic may be an unnecessary disruption to your workflow and an awkward interruption during patient encounters if used in the exam room.

You also may consider:Philips SpeechMike Exec Pro, $429.

Mobile Patient CommunicatorWhat: Education and rooming tool
By: International Medical Solutions
Cost: $149 to $349 each, depending on number of applications.
Contact:www.ims-mpc.comHow it works: A touch-screen tablet offers patient welcome and registration, history forms, and consent forms, but this device also directs patients from the waiting room to the exam room when it is open, and it updates them about their doctor’s arrival. While in the exam room, the patient can watch hundreds of personalized streamed videos and health tutorials.

Physician says: “The patients have taken to them quite a bit,” says Floyd Willis, MD, a family physician at Mayo Clinic in Jacksonville, Florida, who has tested the device at his 20-physician office since the beginning of the year. (Full disclosure: Willis and Mayo Clinic have a financial interest in the technology.) “Our 80- and 90-year-old patients, whom everyone thought would not get along with the device, have done very well.”

Pros: Keeps the patient occupied in reception area and exam room with health education videos and saves nurses from rooming the patient. Keeping the patient updated about doctor’s status also frees another duty for nurses or assistants. Tablets don’t include third-party advertising, unlike some other reception area portable devices.

Cons: Although the tablets include an internal security device to prevent theft, portable devices such as these can get lost. Unless you want some envious patients in your reception area, you’re going to have to buy more than one, which can get expensive.

You also may consider: Phressia, free; InfoSlate (see above).

EXAM ROOM

EnfantWhat: Pediatric Visual Evoked Potential testing system
By: Diopsys
Cost: Lease for $750 per month over 60 months. May purchase at end of lease for $1.
Contact:www.enfantvision.comHow it works: Children, or infants as young as six months old, can be tested for vision deficits, such as strabismus, optic nerve disorders, and severe refractive errors, which could lead to amblyopia. The system uses electroencephalography to examine the visual system of a child, including the nerve pathway between the eyes and the brain. Three sensors are placed on the child’s head, and one eye is covered while he or she watches animated characters and graphics on a television screen.

Physician says: “It’s been a great tool for my office,” says Julio C. Guerra, MD, a pediatrician and owner of College Plaza Pediatrics in Randolph, New Jersey, who had been using the device for eight months at his practice on hundreds of children and detected two with possible amblyopia. “As a pediatric practice, we’re limited with our income, so small procedures are important to maintain a healthy practice.”

Pros: Unlike most vision tests, the Enfant system doesn’t require any verbal feedback from the patient or require the child to be able to read letters. The test, which takes approximately five to 10 minutes, does not require a physician or nurse. Visual Evoked Potential tests have a recognized CPT code reimbursed by Medicaid and most major insurance carriers, according to Diopsys.

Cons: The system requires support staff training. Although the test is short, it requires time added to a wellness visit or school physical, which may not be convenient for your schedule. You will need a secluded area in your practice so the child is not distracted from the screen.

You also may consider: None available.

HygreenWhat: Hand washing and monitoring system
By: Xhale
Cost: $1,000-plus per unit (estimate from calculator on Hygreen Web site. Company spokesperson declined to provide a precise estimate because production costs were still undetermined.)
Contact: www.xhale.com/hygreenHow it works: An infrared signal on the soap dispenser reads the name tag of the person washing his or her hands and transmits the information to an office computer. The practice can generate reports about who is washing his or her hands and how often. Originally developed for hospitals, Xhale will begin selling to private practices next year.

Tester says: “Healthcare-associated infections are extremely costly,” says Loretta Fauerbach, director of infection control at Shands Hospital at the University of Florida in Gainesville, which tested the product last year. “Hand hygiene is a primary way to prevent infections, and the best method to improve compliance that I have seen is this technology.”

Pros: In an era of the H1N1 virus and antibiotic-resistant staph, consistent hand washing is crucial. Being able to record who actually is washing his or her hands not only will help managers track who’s skipping the soap; it also will compel employees to wash.

Cons: Fellow physicians and support staff who wash their hands consistently might feel resentment toward the monitoring device. May be overkill for small practices where hand washing is easily monitored.

You also may consider: Provon by Gojo (hand-sanitizing only), $100 to $400.

IQstressWhat: Cardiac exercise stress test
By: Midmark Diagnostics
Cost: $17,144
Contact:www.midmark.comHow it works: The IQstress is a 12-lead cardiac exercise stress test that works with a Windows-based computer. The patient’s resting ECG can be recorded before the test while attached to the system. The physician or technician can freeze the test results while in progress and digitally review the last 60 seconds, if desired. Each patient record is managed through the IQmanager, enhanced this year, a software utility where previous stress tests are stored and available for serial comparison. The IQstress also is compatible with EHR systems.

Physician says: “Additional procedures in the office always can increase revenue,” says Spencer Barrett Tilley, MD, a family physician in Fremont, California, who acquired the device last year. “Adding Holter monitor readings and treadmill stress tests have been beneficial [because] the revenue is from the actual procedure as well as the follow-up care that is needed.” 

Pros: Even practices without an EHR can reap the benefits of having an electronic record of all the patients who have taken a stress test at the practice, without searching through their paper file. Each physician can configure the system to his or her liking, for instance to generate additional reports during the test. Medicare’s national average reimbursement for a cardiac exercise test is $100.27.

Cons: Expense, plus cardiac stress tests can take 20 to 30 minutes.

You also may consider:Welch Allyn PCE-210 PC-Based Exercise Stress System, $17,800.

CR ProWhat: Computed Radiography system
By: RadLink
Cost: Starting at $35,000
Contact:www.radlink.comHow it works: Computed radiography (CR)systems replace a traditional film cassette with a digital cassette. After the image is taken, the cassette then is inserted into the CR system to transfer the image onto the computer monitor. RadLink’s CR Pro system includes a picture archiving and communication software system-which allows digital images to be shared with your EHR or other physician offices across the country-at no extra charge.

Physician says: “I wanted to have access to digital films and be able to send them over the Internet for someone to look at if I’m doing consultations,” says Martin Gordon, MD, an internist at a three-physician primary care practice in Beverly Hills, California, who has used the system for two years. “It’s been terrific; there are no more chemicals around my office.”

Pros: Conversion to digital eliminates the need for a developer, film, or a file room, reducing time, space requirements, and cost. There are no construction costs to convert an existing radiology room for a CR system because it was designed to work with pre-existing equipment. “If you do 10 x-rays a day or more, you come out way ahead,” says Gordon.

Cons: Cost might be prohibitive if there isn’t sufficient demand for x-rays at your practice. Must already have radiology equipment.

You also may consider:Fujifilm FCR Prima, approx. $30,000; Konica Minolta ImagePilot CR, approx. $50,000.

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