sourceaditya: December 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!