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Medical software goes mobile

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Devices such as the iPhone provide the medical software you're used to—whereever you are.
A drug interaction application on the Apple iPhone

What physician wouldn’t love a product that allows access to broad range of medical reference information and comprehensive patient data? Add to that the time-saving feature of increased hospital rounding speed, as well as charge capturing accuracy, and you have a “dream product.” Several such software products are now available, and they’re quickly becoming an indispensible element of physicians’ daily practice.

 

Epocrates proves “Essential” at UCLA

John Luo, MD, teaches those who practice in an academic medical setting. He is the associate director of psychiatric training at UCLA. He is required to use Epocrates Essentials, a comprehensive medical information resource for mobile devices. “It is a budgeted item,” Luo says.

Epocrates Essentials enables Luo and students to check on lab work and norms for the hospital while on the move. It also enables him to arrive at virtual diagnoses and to check multiple drug interactions for patients.

John Luo, MD
John Luo, MD

“We used to use these drug interaction tables. I might have the patient on Paxil and Risperdol, for example, and the two drugs interact. With Epocrates, you have all the patient’s medications with all their interactions in hand,” says Luo. Interaction checkers include an intravenous drug compatibility screen. The Essentials software enables the UCLA team to scan for drugs, their appropriate dosages, forms the drug comes in, and milligrams available per dose. The software references an infectious disease treatment guide, disease monographs, health plan formularies, pill IDs, pill pictures, and alternative medicines. The company co-authored the software’s disease reference information with the BMJ Group (the British Medical Journal).

Epocrates essentialsLuo uses the software regularly to look up medication pricing and to determine whether a generic form is less expensive and whether the patient’s health plan covers it. “I know that if I prescribe Lexapro for a patient with Aetna insurance, it will cost them $80 per month,” Luo illustrates.

iPhone launch, other software

Epocrates Essentials is now available on the iPhone. In addition to Essentials, the software vendor offers Epocrates Rx, Epocrates Rx Pro, and Epocrates Essentials Deluxe for mobile devices. All products will be available for the iPhone, the iPod Touch, and the BlackBerry Storm as well as Palm and Win Mobile devices by late summer.

Epocrates Rx software offers drug descriptions, formularies, an interaction checker, and pictures of pills. Rx Pro also includes a disease treatment guide, herbal medicines, and the IV drug compatibility screen. The Essentials product is necessary for access to additional features.

Essentials Deluxe is the most feature- rich Epocrates offering. With the Deluxe version, physicians have access to ICD-9 and CPT codes (20,000 codes and counting) via “the Coder” to ensure reimbursement.

The most important feature may be practicality. “The Epocrates user interface is intuitive and easy for any medical practitioner to use from the first day. You can get to information quickly with a minimal number of clicks on the device. This makes teaching other doctors and medical students to use it a simple process,” says Luo.

Access to drug and disease information is also available—apart from mobile devices—via the internet at www.epocrates.com.

MDdatacor Care Center software

Donald Skinner, MD, of the McFarland  Clinic in Ames, Iowa, uses MDdatacor’s Care Center software to locate clinical patient data and identify opportunities for optimal care. (A new product just released from MDdatacor called MDinsight shares patient information with the patient as well as the physician.)

The software consists of a database that aggregates structured data such asMDdatacor: Clinical data, quality outcomes. electronic medical records, labs, and immunization registries as well as unstructured data, such as transcribed notes in Word documents, free-form text in EMR progress notes, and any electronic text-based file. The software collects data from PDF files, continuity of care records, in the XML (the eXtensible Markup Language) format, from HL7 feeds, and Excel sheets.

With this data, Skinner identifies patients in disease control situations who need to keep appointments to keep their disease under control: “When you do population management— managing the health care of a large population of patients rather than individuals— it is very difficult to keep track of all these people. There are people you think are coming in who you have not seen for a while, or there are people who have fallen off the map. With the disease registry, if they are in this particular insurance company’s database [Wellmark], we can find them using MDdatacor and take some intervention to try to get them into the office to provide the care they need, both in terms of disease management and preventive care,” says Skinner.

MDdatacor screens the data it collects based on the insurer’s clinical guidelines (NCQA guidelines in this case) to determine whether the patient’s treatment falls outside processes and outcomes for the particular disease.

If a lab test suggests a particular path for treatment, for example, and the patient has not been in for follow up to receive that care, an opportunity for care would surface in a Web based report at the product Web portal. The software also helps to ensure that practitioners do not duplicate the tests and do not compound the costs of care.

Since MDdatacor was introduced to Skinner and the McFarland Clinic (during a Wellmark Blue Cross Blue Shield of Iowa Collaboration on Quality Primary Care Initiative), the physicians have used the product to support childhood immunizations up to age two and patients with asthma, as well as diabetes and hypertension. “We also use it to keep track of our cancer surveillance, the number of patients having pap smears, mammograms, and colon scopes,” Skinner says.

“MDdatacor is really an indispensable part of chronic disease management. I think it would be extremely difficult to [manage] that in a paper environment,” says Skinner.

Goals and objectives

The objective is to bring the quality of care up while bringing costs down. “Our personal experience is that at first your healthcare costs go up,” says Skinner. The hope is that over time, by avoiding major complications, the product will make up for those initial costs.

But, the results are significant. Patients benefit from both process improvements and outcome improvements thanks to MDdatacor. A process improvement for diabetics might be an increase in the number of people who get an A1c for their diabetes. An outcome improvement for people with hypertension might be an increase in the number of people who get their blood pressure under control.

“There is a substantial improvement— probably a 25- to 40- percent improvement—in the number of patients who get their A1c. We are beginning our fourth year of the project [using MDdatacor] and so that data is based on our baseline before starting this project,” says Skinner.

“We have seen improvement in the 15- to 20- percent range in achieving our overall goals for patients,” Skinner adds. Examples of these goals include getting patients to make behavior changes, eat less, exercise more, and eliminate salt in their diets.

IM Practice Manager

Andras Koser, MD, a hospitalist, CEO, and head physician for Upstate Hospital Services in South Carolina has used IM Practice Manager from IngeniousMed since 2001. The software, accessible from a PDA, enables Dr. Koser to do hospital rounding using the proper ICD-9 and CPT codes to capture all the bills for fast and efficient reimbursements.

Ingenious Med logo“You can use it on a PDA or print out a rounding sheet and use that, entering the data back into a computer after your rounds. Other programs I have tried were too cumbersome for inpatient practice where doctors are constantly on the move,” says Koser.

Physicians can enter new patients into the software in six to seven clicks on their mobile device displays, according to Koser.

“I can teach a doctor how to use it in 20 minutes (for what a rounding physician needs to know),” says Koser. “The person who does my billing loves it. I am managing my own practice. I can generate business intelligence reports including the name of the referring physician and the illness the patient has.”

Before using the software, Koser and his colleagues were carrying pieces of paper with them on their rounds, and they were losing billing captures due to errant coding. “With this program, it is more likely that you will get the codes right. It lets you communicate the codes to the person who actually enters the bills,” says Koser.

The program runs in a Web browser like Internet Explorer on PDAs, PocketPC, and Palm devices. The program comes with an internal chat room for  communicating with other physicians who are seeing the same patients.

“In many medical institutions, the physician is reimbursed based on salary and on performance. So, the program tells you who to pay bonuses to when, for example, a doctor sees more than the 17 patients they are required to see,” Koser says.

With competition, software offerings should increase in number and quality over time. “The company [IngeniousMed] will develop its product based on what the government is looking for the medical industry to achieve in the future,” says Koser.

Insurers are paying for the software based on increased physician performance, decreased costs, and other expectations. As data surfaces about significant improvements resultant from the software, its funding is likely to increase.

David Geer (david@geercom.com) is a technology journalist who lives in Ashtabula, Ohio.

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