sourceaditya: 2009

Wednesday, December 30, 2009

Tweaks and applications to make your PC experience better!

Today a lot of Indian Doctors are waking up to using the computer, maybe to surf the net, or they own a website or better still have an EMR solution. Below are some tips to help you make your time spent on the PC better. These include some mundane ideas and thoughts and also some personal insights in what works best. So make your PC experience a good one, because it’s going to last you a life time.

a. Use the Internet: Today almost every PC is bought with the thought of going online. However for those who are hesitant, it is important to remember the usage and experience far outweighs the ghost of virus attacks and vulgar content. From the EMR software point of view, maximum benefit can be derived from our packages by those who have the Internet to send SMSes, Emails or get support directly online.

b. LAN connection in a clinic: For any clinic which is not a single doctor no receptionist, it is ideal to get a LAN connection with another PC to help manage the work. The efficiency of handling patients and workload multiples manifold by the simple move. Creating a LAN is simple enough and your local computer guy will be able to have it running within minutes. Wiring may take some time if it is elaborate or you can go the wireless way. Our EMR solution works best when used with a LAN connection, clearly dividing the workflows for doctors and receptionists/nurses who can handle the non clinical transactions.

c. Syncplicity: This is a personal favorite of mine. This little software is simply fantastic. Most of us have nightmare about viruses and PCs crashing and losing all our information! Now with syncplicity that can never happen. Select which folders, drives and PCs you would like to back-up, this software automatically syncs it to a virtual representation of your folders online. These can now be downloaded or accessed with a password by you anytime. The whole solution is secure and does not need a huge bandwidth. Now the real goodies: 1. It auto-syncs any change instantly running in the background, 2. Auto-sync multiple PCs at the same location, 3. It has versioning – which means you can see older versions of the same document whenever you wish (Yes even when you changed a “a” to “the” it stores it separately!)

d. Virtual memory: Most computers use not just the RAM but also some part of the hard disk space as memory to run applications. This is called virtual memory as it is an extension of the RAM space into the hard disk. Lot of times your PC may appear slow despite having a decent RAM or gives a pop up saying Virtual Memory Low. For application that use caching, paging and other virtualization techniques they require adequate virtual memory space. Ideally your Virtual Memory should be set to 1.5*RAM.
The following procedure is based on windows XP Professional.
1. Go to right-click My Computer and choose Properties.
2. In the System Properties dialog box, go to Advanced tab.
3. Click Settings button that is from the Performance frame.
4. Once the Performance Options shows up on the screen, go to Advanced tab.
5. Under the Advanced tab, click the Change button from the Virtual Memory frame to access to the Virtual Memory setting.
Then the Virtual Memory dialog box appears on the screen. In there, you are able to check how much the Virtual Memory you set. If you would like to modify the size of Virtual Memory, follow the procedure that is shown below.
1. In there, select the drive letter that is used to install the Operating System.
2. Choose the option that says, "Custom Size:"
Once you choose that option, the setting for Initial Size and Maximum Size become available for you to set. Initial Size (MB) means the actual size of Virtual Memory, and Maximum Size (MB) means the maximum size of Virtual Memory that is allowed to use.

e. Clean Up the Temp Folder: A large section of your hard disk gets blocked over time by the Temp Folder where, partially downloaded files, applications in progress, copy pasted data is stored in parallel.
C:\Documents and Settings\dell\Local Settings\Temp, clear this Folder out from time to time. A similar exercise can be carried out with the Temporary Internet Files located in the Windows Folder.

f. System Restore – Another handy little service that can get your computer back up and running sometimes, but again takes up a lot of extra space that is not needed is System Restore. But System Restore only recovers Windows files, not any of your data. So having System Restore enabled on any other drive other than your C drive (where Windows is installed) is completely useless. Hence keep it turned off.
To fix this one, right click on My Computer and choose Properties. Click on the System Restore tab, you will see all the drives on the computer, if you have a C and a D drive, turn it off for D drive. For system restore, a value between 2% to 4% will be fine in terms of space. The default 12% wastes loads and loads of space!

g. Use a Local Mail Option: Use a local mail option like Outlook, Outlook Express, Thunderbird, Eudora to sync your mails offline from multiple sources so you access them at any time. Even Google Mail provides this option now. Just go to the Offline Tab in your settings and read up about it.

h. Clean with CCleaner: CCleaner is a tool used to clean your PC. IT description on its site is given below – “CCleaner is a freeware system optimization, privacy and cleaning tool. It removes unused files from your system - allowing Windows to run faster and freeing up valuable hard disk space. It also cleans traces of your online activities such as your Internet history. Additionally it contains a fully featured registry cleaner. But the best part is that it's fast (normally taking less than a second to run) and contains NO Spyware or Adware!” So download it today and get your PC cleaned for free.

i. Out with the toolbars: Usually most people end up having numerous toolbars on their application windows. This is most common in browsers, but also tends to happen in Office applications where all the various tools are now on an ever descending bar. The user experience is diminished if half your seeable and workable space is cluttered with objects which take up your attention and are not even used. So my suggestion, for browsers uncheck all the external toolbars from Yahoo, Google and what not, these not only take space but also cause pop-ups and headaches. In case of MS Word or MS Excel, stick to the basic tools on the window, remove the unnecessary, they can be accessed any time anyway. These extra toolbars also cause delays in loading the software or browser.

j. A Free Desktop: Keep a neat clean desktop. It slows down start up and makes you and your PC sluggish to have uncountable number of items on your desktop. My suggestion is create a folder called Desktop items in your documents and create a shortcut on the desktop and dump everything in that. This is if the habit it too hard to shake off. I find it much easier and quicker to work if the Desktop is clean or at least cleaned once in a week to make it fast and simple.

k. Use Bookmarks: Use bookmarks, stars, favorites and other such little programs to make your life on the net simpler. Even our softwares are bookmarked for easy access on the PC as they run on browsers. Why run around to search for the pages already found or remember the long URL which you never will. Just a single click to bookmark them and they are stored forever.

Monday, December 28, 2009

A Clinic today: PC less and less than ideal!

Often I have written about how a PC will help you manage your clinic better, focusing on what would go right is you did have a PC and software to help you manage your affairs. Maybe it’s time to look at this from the other end of the tunnel. What could go wrong if I didn’t have the PC or software! So now consider my clinic Dr. Aditya’s Specialty Clinic, let’s say its specialty is Skin treatments. And to add to this lets say I have no PC in the clinic or even an inkling of technology. Let’s see how it works?

Patient Amit Jain has an intense skin allergy and is looking for a dermatologist in his area. So he searches online for a dermatologist near his house. Dr. Aditya Speciality Clinic is just two lanes down, sadly since he does not have a website or a web presence his name doesn’t figure in the searches despite being clinically better and also closest to the potential client. Well luckily, Amit walking to the bus stop happens to see the clinic and decides to try it first. Leaving your clinic’s walk-ins to luck isn’t the best idea!

Amit now walks up to the reception and asks for an appointment. The receptionist stumbles through her diary to find the correct time slot. Finally after 5 minutes of page turning she settles for tomorrow at 5pm and notes it in her diary. Amit gets no confirmation but a confirmatory nod.

Next day at 4.30pm Dr. Aditya takes in a patient named Amrita Khanna. He had diagnosed her condition and also prescribed her a treatment of tablets and cream for the rash. Now, Amrita has forgotten her paper, also Dr. Aditya having seen over 450 patients since then cannot remember the extent of the rash as opposed to now! So, Dr. Aditya being stressed yells at Amrita, who is left confused. But being a good doctor, he manages to make the correct decision and through experience guesses the prescription. He writes down on a new piece of paper and gives it to Amrita. Amrita goes out and pays the receptionist who nonchalantly charges her Rs 200 instead of Rs 100 and pockets Rs 100 without anyone realizing.

Amit now arrives for his appointment unsure whether it was 4.45pm or 5.00pm, he is ushered in and made to sit in front of the doctor. The doctor quickly hears his complaint and takes down his history on a piece of paper, Amit discusses his problem and Dr. Aditya prescribes him the required tablets and cream. He asks Amit to come again in 3 days at the same time.

At the same time Amrita takes the prescription to the nearby chemist who misinterprets the dosage and gives a stronger medication. This caused Amrita to have a major side effect which was only detected much later.

Amit takes his medication as mentioned, after 3 days he arrives for his next appointment, but since it was not entered in the diary by the receptionist he is made to wait for 2 hours. When his turn comes, Dr. Aditya asks for the entire history again before deciding what to do next, another 30 minutes gone. He gives an injection from his inventory to Amit. This entry is not noted anywhere as it was done in house. Dr. Aditya was surprised to see that only 3 injections were remaining, little did he know his office boy had been selling 20% of his stock behind his back every month during the days of heavy rush to make some money on the side. Amit either ways get cured and his happy, but he still wishes if received a better case paper, more complete details about his illness and the prescription, the doctor had a record of the case paper with him, some kind of reminder for the appointment to make it better for him.

Dr. Aditya is despite being a great clinician knows he can do better if he had all the patient details with him the first time he took their history and subsequent visit wise information. If he had a better appointment system to manage his schedule he would be able to create time for other activities. He knows money and inventory is getting lost in his messy workplace, he needs to get on top of it. The best and quickest solution for this is a simple PC and good software which helps you track your patient records, accounts and inventory.

And if he knew, he would also pray that his prescriptions don’t get misinterpreted, and cause his patients trouble. So a legible prescription pad which can be integrated with the software would seem ideal. And how about if he could store before and after images and help treat his patients better! Hmm, some things to think about in the Technology Zone….. All the above features provided by Clinkare from Plus91 Technologies.

Thursday, December 24, 2009

TIE Summit 09 - My perspective

TIE - The Indus Entrepreneurs is a not for profit association of a very driven kind. It is the largest association of experienced, mature, early and wannabe entrepreneurs in the entire world. Indus standing for India and US since the organization has its roots in the Silicon Valley and was initially formed to network this group with the budding talent in India. So here we were the 2 co-founders of Plus91 on our way to their yearly summit. It was promised to be star studded and educational event. Some insights on what I saw, learned and formed opinions about.

The first session I sat through was tete-a-tete with Ratan Tata and Narayan Murthy, the two most respected names in the Indian Business fraternity. The one question which I was interested in hearing them answer was what a young individual asked, "What is that one success mantra that any entrepreneur should look for or follow or believe in". Their answer was quick, and I think may be to most people there surprising. The both said quite unanimously "Luck". The conditions attached off course were, one should be hardworking, prepared, courageous and all the other virtues of Ram, so that when luck shines your way you do not miss it. But finally it comes down to one word - Luck. Relating this to my own experiences I would say that certain influential factors in my business to have happened because of luck, backed by being good able people, but nonetheless the spotlight shining our way was lucky. May be somewhere it is circle, now come to think of it. You start of a chain reaction which has included some luck along the way which diverts the whole thing right back to you. I think our finding a willing investor, who not only brings money but a vast experience in our field was lucky - (was through an advert for a product in a small publication in a very exclusive newsletter for doctors).

Another interesting session was with Kanwal Reikhi. This man is a demi-god when it comes to entrepreneurship and investment in tech start-ups. It was a simple question and answer session where he acted like an agony aunt to budding entrepreneurs. The best part of the interaction was his very matter of fact and straight forward answers to the questions.

Learning’s -
a. Services are always more scalable.
b. To go abroad appoint channel partners in those locations to build value.
c Focus on one business, do not lose this focus at least for the investor's satisfaction.
d Build a focused and strong team, even if your plan isn't fully polished yet. Build a team of people who know what they are getting into and are ready to focus on it.

There was a special session on Healthcare, though I think it was as irrelevant to Healthcare IT as it could get. Also the main attraction Malvinder Singh of Religare failed to turn up due to weather playing god in Delhi. The interesting part was the companies that did present were unique and interesting. Shramik Saraplasts who are into portable bathrooms was quite a revelation and definitely a company to watch out for.

The other session which did interest us a lot was of Mr. Nilekani. His topic is the rage these days, the UID. The UID project is definitely something which each Indian should look forward to. The uses of the system described by him are numerous and what interested us the most was open API that they are likely to provide developers to use its resources. So how does this help us? Our medical software and online applications can now identify you biometrically or using the UID from an authorized government. No more duplication and no additional work for us, as we use a trusted source to interconnect are records got from various medical entities for the same patient. Already our software has the capability to take this single unified number to tie it to the master record of a given patient. What’s in it for the lay public, imagine not having to run around to prove to various companies about who you are with Xeroxes and certified copies and what not. All you need is the UID and your thumb or your eye! And you could be anywhere in India.

Apart from the above lecture there were many interesting stalls, some innovative products. There were two other healthcare IT companies. The CTO of one of the companies is a friend and was interesting interacting with him. I think the Indian Healthcare IT circuit is still nascent and it needs a mass movement with companies interacting and educating the market together. There are numerous synergies we see with companies like the one above who are into PHR management or with PEAS which is into Patient Education in providing a better value proposition for the complete digital side of their practice for healthcare professionals. It was also interesting to see few doctors in the midst. Some there to promote other activities, most there to promote their newly constructed hospitals or getting into the business of starting a hospital.

What was disappointing about the TIE summit? The genuine lack of financial entities present, by financial entities I would mean VCs, Angel investors, Banks and other entities who would be looking for talented companies to invest in. There was a genuine shortage in quantity and the TIE's effort in promoting the ones that were there. The second thing that was a little irritating was that a large number of the high profile sessions were more about the particular company in the sector or what the sector is about. I think focus should be more on the How and the Why, which was lacking, some where I thought this seems more like a MBA session on values and business case studies rather than a value add to people who have already passed that stage.

Overall I will give the conference a 3 on 5. Next time I either hope to be on the panel or featured in the sessions. The aim is decided and time to get working on it.

Wednesday, December 16, 2009

Designing Personalized Clinical Templates for the EMR

The working of a clinic can be divided into two parts. The administrative portion deals with the business part of a medical practice, such as accounting, insurance, billing , and inventory management. The scale and complexity will depend on the size of the clinic, and is much simpler for single physician clinics, as compared to group practices, for example. The other part is the clinical aspect , where the data captured is clinical in nature. Reports can be created using both these types of data.

Traditionally, clinics have focused only on the administrative uses of medical software, using primarily the appointment and billing modules to help schedule patients and collect payments. The ability of the computer to improve the clinical care of the patient has never been explored properly in India so far.
Why is it so challenging to develop software which a doctor will find clinically useful ? This is because doctors are not able to write their own software – and most software programmers don’t have enough domain expertise in medicine to be able to understand a doctor’s thought processes or a clinic’s work flow.

How hard can it be to convert the doctor’s paper form into an electronic template? This can be quite a challenge for many reasons ! For one reasons, there is little standardization in clinical record keeping. Each doctor loves to develop and design his own medical forms. Doctors take pride in their clinical skills, and each of them does things in their own idiosyncratic fashion. Trying to provide this kind of customization is very difficult for a programmer, because it means spending a lot of time understanding the doctor’s needs, and then implementing them in the program. Not only is this expensive, it’s also very time consuming, because doctors are often too busy to spare the time needed to sit down with the programmer. Even worse, many doctors are not articulate enough to explain to the programmer exactly what it is they want the program to do. This is because they have often not analyzed their own work flows and clinical thought processes, and are quite hazy about these. While they are good at doing what they do, they often are not analytic enough to be able to describe this in writing. Thus, while they are very good at finding faults with the program, they are often not articulate enough to be able to provide solutions! This often ends up causing a lot of frustration for both doctor and programmer!

This is why we have developed a clever model which provides pre-filled generic templates; and allows the doctor to customize these to suit his own needs, so that he does not need to call on us for making any changes he many need !
A doctor who needs an EMR should understand the following basic rules, so that it’s easy for us to convert his paper forms into electronic templates painlessly.

1. How many forms he uses ( for example, an orthopedic surgeon may have a special form for each joint)
2. Whether this form will need to be modified for followup visits
3. Because electronic templates are much more flexible than paper forms, they can be designed much more cleverly. A good doctor will help the computer programmer to design easy to use templates. Thus, those parts of the form which are used most often should be brought to the top; while those which are not essential can be relegated to the bottom.
4. Electronic forms can be “intelligent”, so make use of this. For example, if the answer to: Swelling Present? is: No, then no further fields related to this question will be displayed. However, if it is Yes, then additional fields requesting more information about the swelling will be shown.
5. Remember your question flow when designing the template. This will help you to get used to it quicker and will allow you to pay attention to your patient even while you are capturing data . A good computer program will follow your process, allowing you to become more productive.
6. Finalize your templates and stop tweaking and modifying them all the time – this just wastes time. Some doctors keep on changing their templates, and I still haven’t been able to install their program for them!
7. Unlike a paper form, which only allows you to enter information in a linear sequential format, electronic forms have lots of clever options, such as drop down menus. Not only do these minimize your writing, they also ensure that you remember to collect all the information you need from the patient!

Plus91 has a whole range of templates, individually designed for each specialty, using inputs from its panel of doctors. Your best option would be to start with this; and then change it, depending upon your personal preferences. Plus91 technology is flexible, and allows you to make these changes for yourself! Of course, we can also do this customization for you, if you’d prefer us doing so.

At Plus91, we focus on improving both your practice management and clinical workflow processes in an integrated manner. This means that all the data collected, whether it be in the administrative section or the clinical templates , is captured in the same seamless workflow, cutting down time and effort.

Wednesday, December 2, 2009

Getting IT Savvy - A mental block for the Indian Doctor

The sheer number of times that I have had to actually think about refusing a client because he or she is just too uptight about makes me wonder whether doctor's are all that worried about quality.

I think a there was a wide schism between requirement and delivery in a lot of earlier versions of medical softwares in India leading to a fear amongst doctors about being taken for a ride when purchasing a new IT product. But there is a limit to which this excuse can be used to bargain or actually make a decision.

Any doctor wanting to make his clinic or hospital IT savvy needs to get the right solution other wise it is going to be a dead investment, and there is no salvaging either the product or the doctor's interest in taking a dig at it again. So, why despite this big threat do doctor's tend to bargain like they live hand to mouth when it comes to IT products. This is a very different trend from the big hospitals, who may bargain and call tenders but they never are penny wise pound foolish.

So why this trend? I think it stems from a few reasons:
a. There are no standard suppliers market for these products in the retails segment (read clinics, medical centers, small hospitals) hence there is no real price benchmark.
b. Making a software is a simple enough affair hence you get a lot of 2-bit players, pharma company sponsored softwares, a relative who is an engineer or a local company which makes a HIS system among its entire range, so there are cheap alternatives there, much like a cheap imitation watch market.
c. Today as we make a transition from the old to the new, software hasn't yet become a need for the older generation, so they tend to take it with a pinch of salt, usually with the least hit to their pocket.
d. Doctors have this fascination with getting things cheaper, as a favour or free, it stems from their being an extremely proud lot and from them being mollycoddled by pharma companies since ages.

So what has been the effect of this?
Doctors arguing with me over 2000-3000 rs when they have practices in crores. Doctors taking shortcuts in their software cutting out essential modules because they may save a buck or two. I think sometimes i shudder to think whether this same lot makes its non - IT healthcare and patient centric decisions in this way!

Just yesterday I sent a strongly worded email to a doctor requesting for a software for her hospital. She suggested I should install a much cheaper clinic management tool to manage her multi-doctor multi-department OPD center. I wrote back mentioning the fallacy in doing this, of the sheer waste of time it will be for her and us in getting this off the ground. All because the doctor of a successful hospital would like to save some (a very tiny bit) money!

Tuesday, November 17, 2009

10 reasons to get a PC for your clinic or practice

A computer is standard machinery in most offices today. Invariably some of the better run businesses boast a computer setup. A medical practice is like any other business with a few special characteristics, the most notable ones being: it’s a very personal service being provided and knowledge of this complex service is exclusively with a special few who “operate” the service so to speak. So how does something so impersonal and mundane like a PC find a place in this business? Well we have 10 good reasons why it should find a place in your practice.

1. Medico-Legal Protection

The government makes it mandatory for Doctors to maintain medical records for indoor patients’ period of 3 years. Similarly new bills are being introduced almost each day to ascertain the type and duration of medical record storage. Article 1.3.1 of the Indian Medical Council Regulations actually states “Efforts shall be made to computerize medical records for quick retrieval”.

The data in the electronic format is more secure from theft, destruction and loss if the right precautions are taken. Medical records and accounting information is much more stable and well formatted in electronic form. Hence it is advisable to start moving your data onto the PC. It may just protect you from a legal wrangle sometime down the future.

2. Data Security

As mentioned above data is more secure in electronic formats if the correct precautions are taken. It can be easily backed up in secure locations and also electronic formats present today are a lot sturdier than paper!

Medical records, accounting information, medical notes are valuable information for you, your practice and the clinic. It is a pretty simple choice in moving your data into electronic format; in fact a lot of my clients at Plus91 scan and store their old forms and records in our softwares so that they are secure.

A PC gives you an added resource to be secure about the information you generate and posses at your clinic. Even presentations, lectures and medical notes are better off on a PC.

3. Easy Access to Data

Imagine a patient walks in without her case paper, what do you do? Search your paper records for a copy; that is if you even have one! I know doctors who throw a fit when this happens, but I guess a patient cannot be blamed. What about the times when important decisions need data from old visits or external test reports. Don’t you wish you had them at your finger tips?

A computer in your practice gives you the opportunity to achieve this nirvana. With the right tools and a little training you can have medical records, patient history and even access to online resources to help to make better and quicker decisions.

4. Customer Service

A computer allows you to improve customer service in a multitude of ways. From being able to take and manage appointments more efficiently to generating reports and records quicker, a computer helps you improve the clinic’s interaction with the patient.

Patients often come asking for old records, medical certificates, or with a query which you are not familiar with. In all these cases a computer would help you solve his queries and problems faster. How? Medical record - > search and print, medical certificate -> enter patient information in pre-filled format and print, query -> search for information online or a PC resource to make better decisions or find a relevant doctor to refer to quickly on the internet. Now a days with newer technology better customer service can be provided via SMS and email alerts, online patient interaction, easy record transfers, online appointment etc.

5. Communication

A PC is a very effective communication tool. Right from helping you generate notes and records which communicate medical information to tools on the Internet to let you communicate in general. A PC is a friend when you are in need. Every query will have an answer of some sort on the Internet.

It also allows you to communicate with your peers and post your insights for other to read. Medicine, more than any other domain requires you to be in touch with the latest developments. Books like MIMs are slow to communicate and limited in their effectiveness. Every nation which threatens peace is the one who shuts itself from the world. Communicate because it helps you treat patients better. A PC is the biggest leap you can make in this direction besides getting a cell phone.

6. Save Space!

All those paper records, excess staff required to manage your clinic, overcrowding due to mismanagement of appointments can be avoided by getting a PC. How? Digitizing your patient records help you get rid of them. Make your office paperless, it leaves a wonderful impression on your patients.

Use appointment schedulers to manage inflow of patients. More importantly, an efficient software solution will help you run your clinic or hospital on lesser number of staff. So, yes save space by getting a PC.

7. Generate useful information

Every service or product is improved through feedback, study and statistics. Why should your clinic or your ability to treat patients be any different? A PC helps you capture this information in a logical and effective manner. More importantly it helps you use this information in a more practical manner.

Know how long your patients have to wait, find out what drugs you prescribe more and their actual feedback, find out which patients or procedures help you generate maximum business. And do this within your normal working process. The PC not only helps you capture these, but helps you by giving a systematic and readable output which you can use. A PC provides you with effective tools to help increase productivity and efficiency. In fact many doctors use data gathered to publish studies and write papers!

8. Avoid loss and pilferage

A PC helps you manage your inventory. Using simple office tools or special softwares you can track the status of your disposables items, drugs and other inventory. Many times staff and other stakeholders might steal or take away inventory. Having an ordered system prevents misuse and makes one think twice of taking advantage.

Today, software solutions allow you to auto debit items via bills and also generate reports for per item of usage. A PC is a definite step towards preventing loss and pilferage in the clinic

9. Smoothen Operations

A PC will increase productivity of staff and give them something to work on, even during the lean periods. Also the excitement that comes with using a organized system is something which cannot be discounted. A PC helps smoothen overall operation in your clinic.

Data will be available freely, generate records and reports instantly, cut down on manual repetitive work. Add a new dimension to the work you and your staff do each day.

10. Contribute

A PC allows you or gives you the opportunity to contribute to the medical and knowledge domain. Through emails, blogs, articles you may write which would have gone unwritten, or data you use to support new findings, the PC allows you to contribute like never before.

Contribute to your patient by improving service and efficiency through the use of a computer in your practice. Contribute to your own growth by doing something new today, by buying a PC for your clinic and using it to do the things you only wanted to do but never could.

Finally, clinic and hospitals have been running over the years with or without a computer. A computer may not be a panacea to all your problems or a life changing event in itself. What is does do, is give you an opportunity to be able to do all the above things. All via a single window solution that is your computer screen.

Saturday, November 14, 2009

Top 10 mistakes that’s Doctors’ make in buying medical software in India

Choosing software to run a medical practice has never been easy. Earlier it was due to lack of choices, today it is due to profundity of choices but with too much variability. Doctors are a very unique proposition, few things to keep in mind are:

a. To treat a patient and be confident that your decision is right requires tremendous self confidence. Hence doctors have a strong ego. This isn’t argument whether it’s good or bad, simply put if they didn’t medicine would be a farce.
b. They have a tremendous thirst to learn. Years of med school train you to pick up knowledge and most doctors interested in buying software will have some knowledge. As we have often heard, little knowledge is a dangerous thing, especially for those who happen to make software.
c. Doctors are pressed for time and efficiency, at least most are, hence their decisions are based on the fact that “anything that does not gel with me is going to hamper me”.

Doctors who wish to enhance their practice and provide better care and service to their clients by using technology are on the right track. But keeping the above points in mind they aren’t always going about it the right way. Indian doctors especially tend to lose their way in this nascent market. Some of the important mistakes are highlighted below:

1. Over shooting the requirement:
Some doctors tend to want their softwares to do everything, even pay their taxes (Just joking). Sometimes putting too many things in your software tends to delay its deployment, make it complicated to use and once in a while not taking a software altogether because you can’t find one that does. This is also applicable in smaller doses. For e.g. wanting the entire drug database of 15000 drugs in your software! Now you know you will never use even 1/100th of those. There are enough online resources to give you details when you do require some information. Why then load your software and make it slow by cramming it with stuff you will never use. Rather have a small efficient intelligent database which you can grow over time. That’s what we recommend at Plus91. We even have come across instances of clients giving us 300 page documents of what they want, safe to say half way through they walked into science fiction novel. Stick to the basics, your aim is to improve your practice not solve the world healthcare crises.

2. Acting like a bania:
Investment reaps rich rewards. It’s a simple fact of life. Why then try to needle your way to the cheapest bet. Negotiating is great, but actually choosing quality, support and peace of mind over a few rupees really takes the cake. Sad to say this mentality is very prevalent in the healthcare market space. This is mostly due to its nascent nature where the true value of the product “practice management software” is not bench marked. Simple, unsupported softwares made by the local software engineer are dime a dozen in this IT intensive economy. But in the long run it makes more sense to invest a little more in good software and from a company focusing on the healthcare space. Your domain is intense and deserves respect, someone who doesn’t spend time understanding that cannot make a good product. That is why, people who did buy good softwares bought from vendors which were start buy doctors, because they did have the right idea. Bottomline stop acting like a bania in choosing a package. Every doctor I know earns enough to invest in a good package which will enhance his or her practice. Keeping this simple fact in mind, it’s a mistake that Doctor’s chose quality over quantity, especially if the price difference is barely anything. Chose your vendor carefully, you want them to be partners for life. (For that they should make enough to profit )

3. Thinking someone else knows your business:
A lot of doctors tend to put their trust in what their software vendor is doing for them. If a custom built package is being made, unless you provide the vendor with adequate knowledge on your processes, templates and need, the project will never come out the way it was planned. I know doctors who would give a brief outline of what they want and leave it that. Now the vendor is left scratching his head of what really is required and then when he comes out with a best case scenario, the two never meet or even come close. Always be involved in a project for a custom built solution. Do not boss over proceeding but provide all the information required personally. More importantly take updates from time to time. Many times softwares have been reworked and projects delayed because after delivery the doctor realized this was not what he/she wanted. It is a mistake to leave your customizations in someone else’s hands especially in experienced person in the field of healthcare.

4. Digressing from your need:
Keep in mind what will help your practice. See if the product or project satisfies your pain points and gives you enough bragging rights with your clients. That is your primary aim, get your software and run it with these aims in mind. Anything done beyond this should come later. For example, we have clients requesting for Tally integration in their software. Now, this is a great idea and we at Plus91 are working on it and confident about delivering it. But actually delaying an order or cancelling an order based on this feature is unjustified. Your clinic or hospital has a need to manage accounts; if the software caters to that it is enough to allow you to move on to other nuances of deciding on the package. Many times the process of buying the software has gone astray due to discussions and plans built around these noncore needs. It is a mistake to want your software to do too many things first off, get what is essential at the least and start from there.

5. Waiting for something better:
Doctors tend to become fearful of the time they will spend on the software learning it or using it, that they keep waiting for something better to come along. Unless you don’t jump in the water you aren’t going to learn how to swim is simple adage which applies here. Some of the best run private hospitals I know with roaring practices are early adopters to technology. Today they might still be using legacy systems but they are better run then non IT friendly setups. Softwares will evolve over time, it’s time to stop delaying and waiting for something better, because each day we at Plus91 are coming up with something cooler. We don’t aim to give it to you cheap unless you already own our software. It is a mistake to wait when you can always upgrade! Make use of the inherent advantages of the software industry.

6. Thinking your staff shares your vision:
Many good doctors buy the perfect software and then find that it seems to have not helped at all. Sometimes they blame the software, sometimes they just ignore it and never buy or upgrade again. Most doctors fail to understand that their staff is one of the key stake holders in this process. Unless the staff uses the software and maintains discipline in using the package, it is bound to fail. The software may be the best in the world and solve all your issues, but unless the staff wishes it to be used, it isn’t living upto its potential. Doctors need to be firm and ingrain their vision for the software in their staff. Take to task issues in the early days of adoption of people failing to comply with requirements. It is a mistake to assume that software will be easily adopted by support staff, nurses and fellow doctors.

7. Not nurturing innovation:
Today Indian healthcare IT is a nascent stage. The biggest stake holders in this industry today are the doctors. It is important for them to nurture innovation. Sometimes it is valuable to take a risk or allow a software company to go that extra mile in providing a feature which will change the process flow of your clinic. Using the software in the same stagnant way can lead to a deadlock at this early stage. Doctors who deny or outcast software products which provide extra features or new age ideas because they do not comply with their understanding of what software must do make a mistake in closing the door on innovation. A potential client who asks me to block some modules to save money because they won’t use them is basically closing his own mind to the potential of some new processes improving his business. Do not use it if it isn’t your primary aim, but never close the door, because one day you may realize its potential. Even when clients do not ask for the SMS or Email Plug-in we still leave it on the User Interface, because just seeing that button there will make them realize of all the times they wish it was active and could send out a report or reading instantly.

8. Under estimating your need:
There is also such a thing as going for too less. Your clinic needs software to manage accounts, inventory, reporting, patient profiles and referrals. Why then are you buying some small accounting software which is used in a shop? Here the doctor, either due to lack of knowledge of the products available or to save some money is buying a package which does not really fulfill all his needs. Many a times this leads to him being unsure whether becoming IT savvy was helpful in the first place. It’s a mistake to tackle each item in your requirement list with a separate package.

9. Delaying Decisions:
The single biggest mistake a doctor makes in buying software is when he delays his decisions. Whether it is buying the package or providing requirements or taking delivery. What are the outcomes of the delay? A disenchanted vendor, a even more confused buyer (the doctor now whose thinking even more), a anxious staff and finally a client base who haven’t got the satisfaction of being surprised with a better and more efficient clinic. Situations may have shades of gray but decision should be black or white. Stick by the above saying in making decisions for your software. Making too many changes back and forth in a tried and tested product brings about instabilities which may manifest on-going live. In the healthcare business which deals in lives this is not a good scenario to happen.

10. Disregarding the hardware:
Hardware always compliments your software. As much as the software vendor may try to make his solution lithe (Plus91 products can run on any windows and unix system, starting from 256 mb ram, or even an amd netbook processor) to get best results, have good adequate hardware. Do not be afraid to upgrade, or connect on LAN to help enhance the productivity of the medical software. It is a mistake to invest in new socks without the shoes to nestle them in. Buy good and complying hardware which will help you maximize the benefits of the software that runs on it.

Wednesday, November 11, 2009

Plus91: Making the little things in IT work for your Medical Practice

Softwares in the medical domain are undergoing a tremendous change. Even in India we see some interesting features, services and products built around the technology and scope of what IT can do today (Online consultations, Health Data cards etc). Here at Plus91 we too, think out of the box or sometimes in a very tiny box and design our products to maximize user satisfaction and increase productivity. These small ideas may not seem a lot, but they do make things easier. So it's important to make the little things in IT work for you.

So what are the common doctor complaints about Medical softwares? The most common one I have heard is not being flexible enough to allow me to add data as I want to. Now changing something for each doctor is a cost burden hence most companies do not get into it. But what if I make the software such that making a change doesn't become burdensome. And going further if I can give this tool to you, the doctor. I think it would convince a lot of skeptic doctors to re-think about softwares. Plus91 us aiming to achieve exactly that. Already template modification is a matter of minutes.

The next thing I hear often is cumbersome interfaces and a lot of typing kills the patient interaction and joy of using a software. Today technology offers a lot of opportunity to make life easier. Increasingly we are using little innovations like Auto-Complete options, Intelligent and Self Additive drop-downs and roll over expansion lists to make the interface simpler to look at and easier to use. If one does not provide these neat little tricks on your screen then you may be losing valuable time in entering your data.

Portability is major concern for the doctor, this along with security really makes one re-consider whether investing in a software is safe. Paper at the end can be easily transported and also xeroxed and stored. So what about your data. Plus91 offers unique solutions in Data Storage, online back-up and finally a external hard disk based auto sync system which backs up not just your medical software data but your entire hard drive. We also provide give you an opportunity to share your data via the Internet with your patients through an Online EMR facility. Emailing the report is now a one click process right from the software screen. Lastly we also provide on request our entire package on single pen drives. This is a real source of joy to the traveling physician, now just plug, play and use the package at any clinic or hospital you are at!

Sometimes Doctors need information at their fingertips. It is vital then to be able to traverse through their system within seconds to locate some data. This can now be done with ease using simple interfaces which allow you to open a commonly used page from any screen. Generally a direct link to open a page from where you can access information helps, no need now to remember numerous short cut keys or multiple click processes. Plus91 uses neat dashboards which allow you to access almost any page in the software instantly.

Now what about information from the Internet. Most of us have used RSS feeds sometime in life. So how does it help to be able to use this technology on your software. Imagine a day when you can get alerts on holidays, latest in medications, and other information right in your software to help you make decisions better. Plus91 provides some cool interactive technology which allows information to be transmitted into the software, may it be emails or alerts, for you to access and view on your dashboards.

Imagine you buy a software, what is the one big worry you have when you do! How long will me and my staff take to master the package. Will it delay my patients interests. Now using simple AV help files and a very simple interface with nice big buttons which tell you exactly where your going the time required to master a Plus91 product is considerably less than any other as complex product in the market. Because IT has enabled us to design visually educative graphics which make your job of learning to use the software quick and comfortable.

Lastly, something as easy as auto-remember and spell check is an added advantage which any software should possess. Its not the easiest thing to integrate into a package. As a medical practitioner it saves you considerable time to click on the old entry or know a spelling mistake when you type quickly. So instead of breaking our heads over integrating it we made our softwares run in Mozilla Firefox which provides these features and helps both of us save time.

Sunday, October 25, 2009

10 Reasons for Doctors to be IT friendly and go paperless (well almost)

Healthcare is a business which requires the noting down of large amount of information, transfer of data and making decisions which are again to be captured. So, I guess it is safe to assume that it is a very paper and pen intensive domain, where patient information, reports and daily interaction all happen on paper. Looking at just this one aspect, it becomes clear that IT can play a major part in driving Healthcare if done right.

So what is the downside to all this paper work? I mean haven’t people been doing it for donkeys years. Paper health records have been kept diligently since a century or more, but technology can not only improve the documentation and storage but also improve processes and speed in making, storing, accessing and using this information. So the 10 reasons why a medical setup should become IT friendly in the paperless space are:

1. Be eco-friendly: Less paper used = more trees saved. Extend your care beyond just your clientele.

2. Storage space: Save money on storage space for large number of records and paper based data. As technology improves cost of data storage goes down and that of physical space goes up.

3. Quick retrieval: Retrieve stored, archived data faster on your PC then from filing cabinet. That’s a straight forward challenge. However much data you may have, whatever the number of records, a simple search will help you access the record within seconds. No more walking down dusty aisles of records or browsing through a clutter of files in your cabinet.

4. All Information at your tips: Just today an orthopedic surgeon complained of not having information of the bone replacement he had done for a patient who needs to get it replaced. Certainly makes life tough for the doctor and risky for the patient. So why not go paperless, all your data on your PC, server, backed up at as many places till you feel safe. Information is valuable, and also how quickly can you get it, access information for a patient or an administrative report instantly on your software.

5. Sharing Data seamlessly: Communication is becoming the cornerstone of society. People travel, people use their phones and the internet and the crowd grows by the minute. Getting or giving information which will help make better decisions about a person’s health is a positive outcome of this boom. Its time you got on the band wagon too. Share your e-records with your peers and patients to improve service quality. Improve your productivity by sharing your administrative information and reports with your CA, vendors, pharmacies, pharma companies.

6. Less Chaos: A large setup usually has paper work flowing around the hospital or medical center, usually resulting in a flood. Imagine a place where there is no clutter. A clean and paper reduced office certainly improves the setup outlook. Not to mention more work gets done when you don’t have to sort through and find records.

7. Increased Capacity: A faster records access, storage and retrieval system gives you and your staff more time. It increases efficiency allowing you to spend more time with your patients, and if the word spreads how efficient your setup is, then maybe even see more patients.

8. Do More: Electronic information traditionally allows you to do more with the data you have. Run multiple reports; create informative statistics which help you improve your clinic. Learn how you can improve your business by using resources better. With paper there is only so much data you can sift through. Why work so hard to get what your PC will do for you in seconds. And give it a chance, trust me there are things which you can’t even imagine that your PC might be able to do.

9. Pay Less: Pay less, because what you spend on the becoming IT friendly is certainly less than what you would cumulatively spend on paper, staff, storage and decreased productivity over time.

10. Look Cool: Nice looking software, with some neat PCs, offering efficient service, quality time, and innovative solutions goes a long way in impressing patients. Also with the decreased paper work, the office looks neater and a place you wouldn’t mind spending time at.

Thursday, October 22, 2009

Cool Applications for a Doctor’s Website

A website is many things to many people and organizations that have them. A visiting card on the world wide web, a squatting place on the ever connected information highway, a knowledge source for others to learn, and many more definitions come out of the woodwork after all these net enabled years. Today doctors, just like any other professional or organization are interested in getting their own website, either personally or for their clinic/hospital.

So what are the essentials a doctor’s website should have?
Information about you and your setup, degree and professional details, contact information (with a map preferably), information about the services you provide and finally a query form for the curious ones who want to ask a question. Apart from this basic data some doctors have gone a step further and introduced many innovative tools and content on their website. Interactive patient forms, videos and animations, medical calculators that calculate your BMI and what not, forums, blogs, news feeds, etc. These are some of the things you will usually find on a doctor’s website.

So what else is there?
Well the tools and applications need not stop there. More can be achieved on your website by applications and widgets. They can make your website more interactive for the user and offer patients a lot more opportunity to learn, get serviced and interact with you! Some neat ideas can be implemented which can make a world of difference to your site; which from being a lost in the crowd visiting card on the Internet becomes a beacon of light in the chaos.

So tell me more about them?
A very basic need is appointment management, nothing which an Online Scheduler cannot handle. It comes equipped with an interface to fill in your timings as per your availability on a daily basis. It allows patients to take an appointment; which comes to you as an SMS alert. Go online or through your phone accept the appointment or reject it, triggering the appropriate SMS to the patient. It can be interfaced with Plus91 Practice Management Solutions.

Online EMR and e-Bills offers the patient the added benefit of viewing his/her record remotely along with the bill. This allows the patient to travel and still access the records. It also allows them access to download and print bills for insurance reasons at any time. Lastly, it saves the clinic time and the patient the added effort of collecting certain reports which do not need doctor interaction. Create Patient profiles on the website and allows access via a username and password. Upload report documents to the patient profile, SMS alert goes to the patient who can now access them with ease.

E-Prescriptions are the rage in the USA, companies like surescripts have made it into a completely new business model. Travelling patients will indeed be thankful the day you can start this service. There are multiple ideas in at work here.
a. A patient can send a query about a prescription to you via the website interface, which comes to you as a SMS and you can reply from the phone.
b. You can have a small gadget where patient fill in their prescription schedules or you upload from your software, and the website sends SMS reminders to the patient to take the tablet.
c. Lastly and this is big in the USA but not here, is actually sending across prescriptions from your software or the website to your local or requisite pharmacist, eliminating paper and making the prescription tablets harder to get. Now the patient simply goes to the pharmacy and his prescriptions are waiting.

Content Management Systems are present behind websites allowing the user to change the web content over time. A good content management system allows you to add, update, delete and modify various pages and files on the website from a single simple graphical interface. Making your website cool and up to date needs you to have a strong content management system behind it so you don’t waste your time updating information.

Doctor Connect is a simple concept; there are times in the day or in the week where you are relatively free. So why don’t you allow patients or people to interact with you real time without meeting you. You can consider this a stripped down version of telemedicine via your website. Allow users to come to the site and chat with you on a G-talk or other chat engines embedded in your website. They only see you when you are free and can sign in. Take it one step further by allowing them to SMS queries to you from the website.

News Aggregator, start a news aggregator for your field of medicine. This automatically picks up topics related to your field of medicine and shows it one a scrolling news bar, with links to the articles. These are sourced from across the internet from various health and news sites. Now become a single source of news not only for patients but also for your fellow colleagues, at no extra effort or cost from your side.

Map my Clinic, allows you to use the progress technology has made in navigation. Allow the patient or client to send an SMS of his location to a number which in turn comes to your website, here it computes the best case directions to your clinic using external service providers and sends SMS of direction back.

Allow your WAP/GPRS/3G enabled phone to capture and image and send it straight to your website where you can access it for further study or show it in a public gallery for others to see. These may be patient X-ray or chart images, surgery images, images of patient conditions, or just some cool thing you saw and want to share with your patients.

There is much more we can do with a website! I am sure if given an opportunity we can make it much more than just a visiting card on the internet. Coming soon, by Plus91

Monday, October 19, 2009

Accounts: A Doctor's nightmare - Made easy by Plus91

While doctors love earning money, they hate keeping accounts ; and interactions with accountants are high on a doctor’s “hate to do” list. A doctor who owns his own clinic has the thankless job of having to maintain accounts. Most doctors have varied methods of maintaining financial records, but all of them get the jitters when it comes to filing their income tax returns. So much paper work and so much time wasted ! Isn’t there a simpler way of managing your accounts? Well technology and softwares run banks, so why not your clinic as well ?

Plus91 has integrated its Practice Management EMR solution with a simple and effective accounts module which manages earnings, general payments, HR payments and referral payments . Here’s how Plus91’s billing module helps you keep your accounts.

My patients usually come in one after the other. It is difficult to keep track of how many came in and also their billing status. Making the receipts is a very cumbersome process for my secretary. What do I do?

The accounts module in our software packages is integrated with the visit management, and allows you to automatically create bills and receipts during the patient visit within seconds. It accepts inputs from the EMR and auto generates the bill with rates you have entered earlier, so that no time is wasted in billing. This means you no longer have to go through multiple screens just to prepare a bill for a patient. Plus91 allows you to generate the bill during the patient visit within seconds. You can also keep track of the bill amount and payment status in a single window , thus making life simpler for you and your secretary.

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A lot of time my patients pay their bills piecemeal This means that their payments for earlier visits is often pending when they come for a followup visit. How can I collect the pending payments more efficiently ? It is irritating to go back to the old account books and make a list of payment pending entries. I need something which is more efficient !

Yes, making lists of pending payments can be quite cumbersome, which means a lot of time the patients default on their payments and you lose this income. Plus91 remembers which bills have been only part-paid. This means creating an unpaid bills report ( accounts receiveable) is just a simple click away. When the patient pays the remainder due, you just need to update his billing record, and his name is automatically cleared from the pending list !

My CA ( chartered accountant) insists he wants all income and expenditure neatly filed under various heads and given to him in an Excel sheet. It is tough enough to put everything down on paper – putting everything on Excel is twice the work ! Can software help me overcome this problem?

Many doctors cancel their appointments and stop seeing patients for 2-3 days every year when they are stuck at their CAs. The reason they waste so much time there is simply books are a disorganized mess of registers, papers and bills. Going electronic allows our intelligent software to do the work for you , so you can earn more money seeing more patients ! Once you start using Plus91, the amount of time you will save in interacting with your accountant will more than make up for the cost of the package in the first year itself !

Plus91’s accounts package allows you to create ledgers ; profit and loss statements; and allows you to export all this into formatted excel sheets, making your life much easier. Soon, you will be able to export this into Tally , making sure your CA votes you as being his favourite client !

How do I make sure my staff hands over my daily collections to me ? How can I monitor them more closely to make sure they aren’t siphoning off my heard earned money ?

Even though doctors are daily wage earners, they are surprisingly naive about handling money. A lot of their income is in cash; and because they are so busy, they often have to trust a clerk or secretary to collect their fees. This makes them easy targets for embezzlement; and the embezzling is usually done by their most trusted staff member ! What do you do if he “forgets” to enter a patient in your register ? Or if he fails to prepare a bill and pockets your money ?

With Plus91, each patient you see is present in the system , so it is easy to keep track of how many you have seen. Since creating the bill in part of the clinic process flow , this allows you to track the status of each patient with respect to their payments !

I don’t want all my staff to know how much I earn ? If I keep all my financial transactions on Plus91, then every one will know what my income is !

Plus91 allows you to set passwords, so that privileges are set for each user. This ensures that your staff has access only to what information you want them to see. You can keep whichever part of the record you want confidential and do not need to share it with them if you do not want to .

Many of patients have health insurance and I need to get the TPAs to pay my bills. They want me to format my bill according to various heads – and these rules vary from TPA to TPA ! If I want prompt payment from the insurance company, I need to do this. Will Plus91 help me?

As health insurance takes center stage in India, TPAs are insisting that the bills you submit to them for reimbursement be created in a certain format. Because they control the flow of money, they can pretty much demand this, and doctors will have to comply.

Plus91’s claims package has integrated these formats into its solution. By choosing the correct option, you just need to fill in the appropriate fields and you will be able to complete the formalities in a jiffy. What’s more the software allows you to re-format the bills as needed, allowing a lot of flexibility.

I need my inventory and other payments to be managed directly, without having to make entries twice. Having different programs to do this reduces my efficiency !

When you purchase medical equipment ( ranging from a chair to office stationary), you have to create a voucher for the same; make a debit entry in your ledger and also make an entry in your inventory register. That’s two steps too many for a simple purchase ! Plus91 allows you to do all this automatically by filling one quick form. Just add your voucher and let the software do the rest.

I have to track doctors who refer patients to me . I need to be on top of this so that I do not lose out on patients. Can you help me with this?

Referrals are an integral part of the Indian Healthcare system. There’s no need to waste time doing these calculations if you use Plus91 ! Plus91’s referral systems keeps tracks of all the patients referred to you by various doctors. You can generate month end reports in excel and send them to your referring doctors.

My billing needs to be very flexible, as I often have to give a discount to poor patients. How can you help me to manage this ?

Plus91’s billing module allows you to be very flexible . You can add a discount or a tax as needed; or charge different rates for each of the procedures you perform.

Tuesday, October 13, 2009

Medical Softwares of Old: Slow to catch up

Technology infiltrated medicine a long time back. On the hardware and pharma front it was growing leaps and bounds before software even had it boots on. So why did software get left behind. Well my version of the story is that it didn’t get left behind it was just slow to learn and grow. Since the time the PC was invented and programs to go with it, something was being developed for the medical front. It began with some very specialized sections which are today well entrenched in the practice, eg. Imaging softwares for a radiologist, however the major portion was just left behind and slow to adapt.

Focusing on India, our culture dictates the doctor to be a know-it-all but with a human touch. How then can he peer into a screen and provide good service and also need to peer into a computer in the first place. While technology from the outsourcing point of view was quick to catch on, its entry to main stream lives has still been slow. Today doctors are finally waking upto the possibility of softwares enabling to service the patients better. The softwares on their part are adapting to the working style of the doctors using newer concepts and clearer process mapping. This reduces the direct use of PCs during an examination or consultation, and more importantly people have begun to understand that using the software helps provide better service and not as a replacement for the doctor.

So why were the old software not too keenly looked at by the doctors. It is only in the last 2 years that great interest is being generated. In the next few years there could be the boom of Healthcare IT, but what went wrong before. The major reasons were:

a. Unfriendly and complicated user interfaces: Medicine is complicated so the software should also look complicated
b. Rigid work flows: Dictating terms to well settled practices never really got any one to happy
c. Large learning curves: No time to learn and use a software especially if it is complicated or not as per my work flow
d. System requirements: Softwares worked on some PCs and some configurations. Investment then into something like this was not a small amount.
e. Too narrow in capability: Softwares did such specific tasks that it required two separate ones or paper work to be done side by side for managing the entire setup.
f. Paper is King: Government regulations required strict paper storage policies to be implemented. They weren’t aware of the possibility of EMRs.
g. Game changing features: Were too few and up to the mark. Today innovation in this field is lighting up a lot of doctors’ faces. Eg. The practicality of providing online EMR for traveling patients is important, and it wasn’t available few years back.
h. Time to customize: Was slow and time consuming. Hence deterring a lot of doctor’s from taking the plunge or quick and innovative development from taking place
i. Sales avenues for softwares: Sales channels were not well defined in the nascent market. Today the internet, ease of buying and carrying laptops and also ability to provide videos, demos, and literature goes a long way in educating and finally selling softwares.

Sunday, October 11, 2009

Software Features Most Appreciated by Doctors!

I come from a company and a team of of very innovative people. Since the last 3 years we have tried to include, in most cases successfully and in some cases still trying to introduce game changing features into our softwares. These software products are specifically targeted at doctors and hospitals in the Indian Market. We have tried to keep a realistic outlook towards usability and need in developing these features, though some are for the pure thrill of it. Below I have listed some of the features we offer that are really being appreciated by the Doctors.

1. SMS and Email integration - Simple, yet effective in communicating with patients and doctors alike. Today India communicates on the Mobile so why not the doctors.

2. Data Protection - Online back up to save data and download it any time in case of a crash or back your entire PC onto a device provided by us. Keeping the data safe has always been a priority for doctors and hospitals, now you can.

3. Point and click interfaces - Simple Graphical User Interfaces makes life and learning simple for the doctor. Minimal learning curve ensures that the doctor and his staff are using the software within days to its maximum benefit

4. Online EMR - Offering doctors the expertise to offer patients their records online for easy access, especially patients from far away or constantly traveling. Takers for this are few and far, but those who understand the implications of this, really appreciate the scope of the progress that is being made.

5. Online Support and Updates - Now no more waiting for help to arrive is how I best pitch this service. But trust me, one actual live use of this service and the doctor is sold on it for life.

6. Structured Reporting - For every specialty in medicine we support, we appreciate that the potential outcomes are numerous. That these outcomes can be displayed in a structured way to quickly select, display and publish reports to make this a mundane and quick task is a vital feature in our PMS. Doctors increasingly appreciate this intelligence structure to help them quickly select report templates and publish reports.

7. Referrals - Referral management module has been a boon to those doctors which keep track of who is sending them how many patients and any monetary implications of the same.

8. Exporting Data - Export to Excel feature is very well appreciated by Doctors as it helps them to send data to CAs and other external sources without any headache. Soon to come, export to Tally.

9. Auto-Complete and Auto-Add Drop downs - A simple technical mechanism to help manage drop downs better. Increases data entry speed and also makes the software User Friendly. Doctors immediately recognize this and appreciate the capability.

10. Adding attachments - Scan or capture and attach videos, images and documents to the patient record. This feature proves worthwhile for a myriad of reasons. Doctors are happy to be able to be flexible in their approach and attach everything in a single location.

Friday, October 9, 2009

Initiating Online Installation and Support

As I write this blog entry I am traveling back from Bhandara near Nagpur having completed an installation of Ultrasite with a diagnostic center. It has been an effort to do so. In the long the run maybe the experience is worth it for me personally but the it just goes to prove that the alternative is much more effective. In the last week we completed two installations at Varanasi and Solan without visiting the locations.

I think the era of using the online methodology just not to market but also to deliver and deploy is here. And people in India, at least all doctors I have interacted seem comfortable with the whole prospect. So the biggest hurdle seems to be clearing itself. But thats just half the problem solved. How does one tackle delivery, technology, training, information exchange and also payment online.

For one thing its vital to have a good site which promotes information sharing easily between clients, potential clients and yourself. Secondly it is vital to have a good software setup which allows remote management. Teamviewer, Log me In, even Windows tool are quite effective. Next, your process flow for installation or providing support should be simple and well practiced by you. At Plus91 we take about 10 minutes to complete an installation.

Now things we have learned here are: Some times if the clients net connection isn't fast it makes sense to courier him a CD with the executables or ask him to download it from secure temporary links on his own free time. However our files aren't so big but then again the Internet speeds in India arent brilliant everywhere either. Next it is vital to be able to provide training remotely. We have devised online training tools on our website. A comprehensive help manual and most important of all Audio Visual Help files which run like videos going over each activity in the software. I still get the occasional confused call but its reduced considerably.

Email and chat are the best ways to exchange information and track any changes required. A formal system on the website is also a good step. Lastly payment by Neft nowadays is a very simple process with each branch of each bank connected. Doctors usually never have a problem with this part though they do argue about the pricing :).

Over all I think my company with its small sales force has been able to serve, cater to and also manage sales far away due to this method. My cost is minimal with investment in a good remote software, time for formalizing and practicing my process. But dividends are rich, I have clients in remote areas, some whom I haven't even met. The buck doesn't stop here though there is till room to improve and streamline. May be in a couple of months Ill come back to this topic and mention what we have learned.

Wednesday, October 7, 2009

Practhett is back with "The Unseen Academicals"

My favorite author is back with the 32nd book of his belligerently satirical and diabolically funny Discworld series, the unseen academicals. This is the disc shape world and Terry's imaginative swipe at football clubs and varsity sports. And I cant wait to get my hands on it.

To the uninitiated, Terry Pratchett is an author who worked at a nuclear plant before deciding its much safer writing about the world's idiosyncrasies. To be safe he invented an imaginary place called discworld where he took humorous swipes at modern day problems. But why do I love him so much, because well his writing style, his witty remarks and his objective way of describing subjective incidents using various motifs is just down right fun to read.

Some times if the world were a more simple place, I think I would make Pratchett compulsory reading. Not only does it bring a smile to your face it also teaches you what all is really wrong with the world, sometimes with pointers in the right direction. Below are a few samples of my favorite quotes from Pratchett.

1. It is said that your life flashes before your eyes just before you die. That is true, it's called Life.

2. Give a man a fire and he's warm for the day. But set fire to him and he's warm for the rest of his life.

3. The figures looked more or less human. And they were engaged in religion. You could tell by the knives (it's not murder if you do it for a god).

4. The Monks of Cool, whose tiny and exclusive monastery is hidden in a really cool and laid-back valley in the lower Ramtops, have a passing-out test for a novice. He is taken into a room full of all types of clothing and asked: Yo, my son, which of these is the most stylish thing to wear? And the correct answer is: Hey, whatever I select.

5. “Most species do their own evolving, making it up as they go along, which is the way Nature intended. And this is all very natural and organic and in tune with mysterious cycles of the cosmos, which believes that there’s nothing like millions of years of really frustrating trial and error to give a species moral fiber and, in some cases, backbone.”

Now thats class...

Tuesday, October 6, 2009

Top 10 reasons why doctors say NO

Doctors being in the business they are, are pretty straight forward people. So selling softwares to them can get interesting especially if they are not interested. The healthcare IT and medical software market in India is still very nascent. Doctors are just waking up to the fact that some thing exists. Also the ones who have taken up some softwares usually find themselves using products that do not satisfy their needs. The medical software market is slowly coming to terms with the complex work flows which needs to be displayed for quick entry while the doctor caters to a patient. Hence, there are issues there too which are sorting itself out albeit slowly.

So the top 10 reasons why Doctors say NO to medical softwares in India are:

1. I am not IT savvy and do not want to invest is buying and learning new stuff (Here is a good opportunity to actually make some one realize the potential technology can make)

2. I am too old or old fashioned to invest in a software now (Probably the toughest lot to convince, usually unless you see some hope during your interaction should be left alone)

3. I already have a software and I quite like it (Can be tough to convince if they are in love with their old software, but there are methods to convince especially if your product is better)

4. I bought a software but i wasted time and money, was of no use. (Require to prove your credentials through references, product demo, hand holding. A lot of my conversions have happened from this category)

5. I am not to keen to introduce a software in my work flow, do not have the time (Here its all about your software workflow and convincing power, the aim to prove that once settled this can make you see more patients, if your so inclined to your business we can actually improve it)

6. I do not think the software meet my requirements, I want more/less/something different (Well our paradigm is simple, each doctor is his own boss so they tend to want it their way, so how do we make this feasible, by letting our technology let us develop and modify quickly, so usually we say yes we can)

7. I do not want to meet you, as I am not interested (This is a tough one, because unless I can talk or show my demo its a zero percent chance, usually we leave behind video demos, brochures or cards, for later reference)

8. I prefer the cheaper or free option I am getting from my relative/pharma company/local provider. (Show them a feature, ease of use and cost benefit analysis vis a vis your product. Also offer them pre-determined discounts showing you care and understand where they come from. But keep a base level beyond which you do not compromise,tell them they have to pay for better quality and service. Show them you are better and confident about it, with respect comes a change of heart, well sometimes)

9. I like to use my writing pad (Tablet PCs, intelligent forms and voice transcription are here, and they are getting cheaper, pretty soon I know my company is going to render this excuse obsolete)

10. I do not have a PC (Offer them good deals through your vendor, hand hold them initially in case you see a glimmer of hope, because if they like you first time, they are your customer for life)

Monday, October 5, 2009

Poker Mania in India

Poker seems to have really caught on in India, I think receiving an invite to play on a completely "Indian" poker site signals the advent of poker mania. What began as a simple friendly pass time a year and half back has now become a virulent passion amongst the rest of the junta. We began as 5 friends who wanted to kill time every other Friday night. Today I get calls from other friends who organize 70-100 people tournaments in fancy hotels and people are ready to pay for thrill of the win.

So why does poker evoke such passion, its know to cut across all boundaries, women seem to enjoy it too! Isn't it just another card game and a gambling habit. Well it's both and a lot more. Just like Umberto Eco's Foucault's Pendulum is the thinking man Da Vinci Code, poker is gambling card game which requires a lot neurons up there and a lot of balls down there. It easy to pick up but very hard to master. It just doesn't involve learning what to do with your cards but also involves knowing what to do with your opponents twitches and body movement. It even involves some maths, ohh that painful little branch called probability. People who would curse maths, live by it and can calculate within seconds the odds of a card coming on the poker table (Much like that Gujju trader who may have failed his 12th but still make shit loads of more money than you on the market and knows all the bhavs).

All in all its a fun time to be a poker fan in India. Things are looking up, from back room private tables at peoples homes to well organized tournaments like a pro sport things are moving quickly. I think its time we got our own entry leg into the WSOP. What say guys Ive been hearing it for a long time, someone better make it happen.

Saturday, October 3, 2009

Taking Indian Healthcare Online: Are we ready yet

A lot of websites today claim to offer a host of services for doctors and patients online. Some of these sites are very innovative. They all looks good and give you the feeling that Indian Healthcare is definitely going in the right direction. But how effective is their approach from the business reality point of view. How much of this is going to work today and not in 3 years?

From the business perspective I think it’s a little early to go completely online, a company only offering web based services through a portal. The biggest in road you can make today with doctors in India is offering them local solutions which have an internet backdoor offering them additional services like Online EMR, record transfer and online scheduling etc.

Of course the ultimate aim is to take it all online (our own infinitehealth which is in internal testing at Plus91 is a step in that direction) but a complete model based only on online services is still some time away in gathering steam with the Indian crowd. Just few days ago I got a beauty and slimming clinic currently using an online billing, form handling and CRM software coming to me for a local solution where they can access parts over the net. Their biggest gripe Internet speeds and flexibility levels.

I rather think it makes more sense to build technology which can be internet friendly and also highly flexible giving a low customization time and cost to incorporate. This not only makes business sense but also gives the doctor the joy of getting what he wants (A very very important factor when considering Indian Doctors).

On the online medical record transfer front there is a constant debate about how to best attack and monetize it. Today offering someone the hypothetical solution of transferring data online will not sell so easily and will not be effective unless a large number of people sign up in a closed area. I have in Pune, clients in one area, a lab, a diagnostic center and a mid size hospital. Prototyping the technology to manage the record transfer for this local group and marketing it to them seems worthwhile. Selling solutions like record transfer will only work when sold as a cross service to existing practice management clients to ensure growth as they get maximum benefit. On the other front I get actual solid clients for this rather than someone signing up the first time because it’s a new service and never using it. Much like the way some of these websites seem to be managing.

Friday, October 2, 2009

Tata Photon – Finally On

I have heard so much about the Tata Photon, that finally when I had the opportunity to take it up I did so with both hands. But thanks to some very convoluted policies and less than knowledgeable customer service executives it wasn’t easy. I recently bought a HP laptop and received with it a voucher for the Tata Photon service. So I went and submitted the paper work and things were going smoothly. As I was travelling my activation visit was delayed, having specifically told them that I was out of town.

On coming back I waited and waited, when no call was forthcoming I called the customer care who told me that a complaint was lodged and someone would call. Again I waited and waited but to no avail, finally frustrated I went to the Tata Indicom store. And to my horror they told me my application was rejected as no one was there during their verification. I told them I did mention I was out of town. They agreed with all I had to say, but their actual excuse was that once it was done in the system I could not avail of the voucher again. Now this really irked me, because the problem was a solvable one and using the excuse of the “system” was a try at making it an impossible one to solve. Moreover when asked why the customer service person I called never mentioned anything, he said it was because they don’t know anything.
Either ways I decided to send some email complaints. I wasn’t disappointed by the Tata Services because at the end it has always come through. The email was exactly sweet, and was sent to the right people (that does go a long way in getting things moving), so within one week my connection was on and the mysteriously their system now accepted the entry. On the whole few things can be learned from this:

a. Big names like Tata really develop a lot of trust by taking action when it is necessary, despite an initial goof up they did come through in double quick time

b. Communication and to right people is important to get a move on things

c. Blaming the system never convinces any one. It in fact can get a lot of people angry because it of no concern to them. Never use an excuse about your internal functions to swat away a complaint.

d. Finally two thumbs up to Tata Photon, I think it is way better than the Reliance Netconnect.

Thursday, October 1, 2009

Mumbai Ultrasound Course 2009

The Mumbai Ultrasound Group organizes a conference once every two years with the slogan “education for all”. It is a very informative and study oriented conference with 4 days of sessions teaching the basics as well as the nuances of radiology and sonography complete with lectures from the experts and live sonography sessions showing how it is done. This year at the Mumbai Ultrasound Course 2009 over 300 radiologists and sonologists descended onto the JW Mariott in Mumbai. I was lucky enough to be there with my company Plus91 Technologies owning a little piece of the sponsors’ real estate.

It was a pleasure to be in the elite company of Siemens, Toshiba, Bracco among others each having their unique stall. It was really interesting to see how each company had for the lack of a better work presented their stall, capturing what is most essential for their products. For these medical hardware measures coming for such conferences is old game and they have complete ready to assemble stalls complete with props to make the best impression. We had our own stable space which we adorned with the tools of our trade the laptops. One had a running video demo, one a running presentation and the other for giving demos to interested clients. Lastly we had a hand held tablet PC to show the consumer in this case the radiology delegates how simple things have become.

The first learning was position is everything; being the first or the biggest stall didn’t matter. Being at the right place did. I think we were lucky for both conferences in that respect. In 2007 we were right next to the food court which means each and every delegate saw us and stopped by. This time it was thanks to the most popular and fast selling item at the conference namely books. We were right opposite the book publishing company stall, so we had a constant rush about us. Any doubts about how do we shape up against these fancy stalls was driven away by the fact that most of the crowd most of the time was next to us. Now it was just a question of approaching them.

The other major learning has been the power direct contact with a mass audience can have on your conference. Dr. Mukund Joshi and Dr. Alka Karnik were kind of enough to allow us a 10 minute slot prime time during the conference to address and demo the software. Here I think I hit the nail on the head (little flattery is ok) by attaching importance to improving your service to the client and increasing the efficiency of your business. I painted for them a picture where their needs go beyond just giving the patient medical advice to actually providing better service and also beyond just running a setup to running a efficient easy to manage clinic. My quick and spontaneous speech highlighted the fact that an easy to use software with just the features I have is ideal for their needs. It clicked because I did see numerous nodding heads! And they did flock to me after the last session during the banquet and that’s where we got most of our sales done.

Lastly I think at any event where we are marketing or highlighting the company it is important to always know what the closure process is. We had decided to hand out CDs to people who did purchase the software, but almost of all of them agreed to do the final installation online. I think this is an added advantage to Plus91, where we have perfected the technique of installing our softwares over the net remotely with minimum bandwidth and fuss. Added to that nice easy to understand video demos make the job of training almost redundant. This helps us cater to and sell to clients beyond our physical reach even without the CD if need be.

All in all MUC 2009 was an enjoyable experience and was good for the company. And to think we almost didn’t make it there.

Wednesday, September 30, 2009

Technology and Doctors in India: The love hate game

When a transition starts it’s always said to be a confusing and muddled place. In the Indian medical sector as technology and healthcare begin to mix in India at a grass root level this is seen by the demands and concerns doctors have in accepting technology.

Over the last 3 years I have had a pleasure of meeting a whole range of doctors, from various cities and expertise in multiple disciplines. I make and sell softwares to Indian Doctors. Without delving too much into the products they are simple, process oriented and with a lot of value-adds. So should I be selling well in this unstructured and nascent market? The answer is not really, the reason is the transition. As doctors come to grips with the fact that technology is now not replacing them but making them adhere to a new set of rules and processes which they never have followed before they resist accepting it.

A large part of the blame also falls on the original providers of software, a lot of it was not from the point of view of the doctor. Bulky and cumbersome process took away time from the doctors core business interest his patient. So whatever the software needed to do, it needed it to be done seamlessly and easily. Today with hardware and also software technologies this problem is finally being overcome. But the doctors, now once bitten are twice shy.

The second issue is that the Medical domain is a one of grey heads, ie the major professionals who can or require to invest in a software today are 35 and above. The younger lot is still studying or working in public/private hospitals where decision making is still not upto them. So largely, we are dealing with a set of doctors in India who aren’t exactly tech savvy. This does hurt the numbers in the overall scheme of things. Though it is not the 100% rule, it does take away sizeable chunk of the population. However there are ways and means in overcome this problem. Doctors are after all people and people like to put their noses everywhere, especially if it benefits them.

Today, about 3 years into my business I have formulated some game plans to counter the usual reasons for not going ahead for IT enabling one’s setup. For hospitals, chains or even polyclinic where there is management involved it far easier. The real challenge lies in convincing 400000 doctors who run clinics and small practices in India. Whoever convinces them first gets a big bonanza, because mind you once this lot starts they will not stop. Trust me, I’ve lived with two doctors all my life.