How much should I spend on technology for my practice and my patients? A Doctor's Dilemna

Ask any doctor this question and he or she will give varying degrees of numbers, but all will unanimously say they are willing to spend. So what can a Doctor spend on to improve practice and patient service? Before we examine that lets break down what qualifies a good doctor in terms of attributes other than his or her personal attributes and knowledge.

a. Doctor should have a clean clinic
b. Doctor should provide the patient with his or her medical record
c. Doctor should be able to recollect or see the patient’s history at each visit to give accurate treatment
d. Doctor should be able to provide proper bills and receipts to the patient for the service deemed
e. Doctor should be able to communicate with the patient or another Doctor, his notes and views in case the patient is travelling
f. Doctor should be reachable by the patient in times of emergency
g. Doctor should be able to communicate changes in clinic, timings, services etc to the patient and other stakeholders
h. Doctor should educate the patient on every disease, treatment or procedure as and when required
i. Doctor should take proper consents from the patient before any procedure or treatment
j. Doctor should have all records and accounts properly maintained for the clinic
k. Doctor should adequately reach out to the general public to educate them about his or her clinic and services
l. Doctor should not have an over-crowded waiting room and have a proper appointment system
m. Doctor should give proper instructions on steps to be done by the patient and also a clean legible prescription.

These I think any doctor will safely say should be a must. Off-course there are many things that can be done which can be considered extra or out of the way, but nonetheless those who wish will do them.

So to do the above things in a proper manner what are the things that should be looked at?

1. Having a good clinic or area of practice. It should be neat, clean and inviting.
2. Medical Records with patient history for the patient and also kept with you are a must
3. Prescription which you can access and the patient understand is needed
4. Tracking patient appointments and visits
5. Means to communicate with a single patient or all of them is a whole is also vital

So what are the cheapest ways to this?

While I can give you the conventional methods which seem that they are cheap to do the above things, in the long technology does provide majority of the answers.

• Software can improve your clinic area and make it paperless and uncluttered
• Software can help you maintain all your patient records, history and accounts
• Software can help you give out legible and accurate prescriptions
• Software can help you track your patient appointments
• Website can help you communicate with your patients and vice versa in a simple effective way

So a good software and website does help the Doctor improve their practice. Anyone saying “NO” is simply trying to fool themselves. So then why are doctors so wary of investing in them?
Because they are scarred, either they think they’ll get fleeced or they may not get the desired value out of their investment. A lot in fact are happy in their world and don’t want to change. Too bad the world around them is changing.

Any good investment or quality service comes at a price. Service and Security come at a price. There is a reason why the public hospitals are still trusted in India, they have quality due to the sheer man hours put in by the Residents, Honoraries and Teaching staff. Software companies too similarly put in hours of work into a good product. The end result comes at a price, in this case a value attached to the service that is being provided. We at Plus91 value what we are making in the EMR and Website space. It is time doctors realize this and invest accordingly.

As a Doctor I want IT to enable….an Indian Doctor's perspective!

As we improve on our software products and work with more and more doctors, we see trends which make us realize where the Doctors see Healthcare IT taking them in the future. This experiential learning is solely focused on Indian Doctors and our interactions with them. Highlighted below are some key points which enlighten us how Indian Doctors view IT as an enabler and in which processes. In an ideal scenario I think the topic name would be the ideal blog post highlighting the same age old points of what aspects should IT drive in healthcare services, but this isn’t one as doctors like other people have their own skewed requirements.

To begin with let’s see what the ideal points in order of importance would be:
1. Computer Based Medical Records (EMR)
2. Clinical Information Sharing Networks
3. Clinical Decision Support
4. Administrative Functions – Accounts and Patient Profile Management
5. Computer Generated Prescriptions
6. Better Patient Communication and Care

But interacting with Indian Doctors over the last 4 years, we have had a whole different set of requirements and priorities. It is an eye opener in some respects and helps us shape our business to the market needs. In some cases though it is wiser to take the higher road and try to change the doctor’s perspective.

So what does this list look like?

1. Accounts and (Mis)-Management
Indian Doctors give a lot of weight to accounting in their Clinic or Hospital Practice Management Software; they expect the package to bill as per their requirement. What is more surprising is their customization to deduct on the accounts despite capturing the details. Being a predominantly cash business, this is an understandable request; however we do not parley with such requests. The software must help them track their inflow so that they know what business they are generating daily, weekly or monthly.

2. Referrals
Referring patients to specialists and other clinicians is a common enough practice the world over, but in India it takes a monetary angle. Doctors want to know how many patients they were referred and by whom, so that they can make the necessary payments back to the referring doctors.

3. Medical History
Doctors want to keep their patient information with them to help make better decisions. While doctors are still uncomfortable with decision support tools, they however are opening up to the fact that medical history can be extracted any time once loaded on the software. This is a good beginning to convincing a doctor those other aspects to can now be automated.

4. MIS Reports and Registers
MIS reports and registers are a commonly asked feature or requirement amongst Indian doctors. Sadly the uninitiated ones forget that data needs to go “in” first for it to be extracted. The reasons for the MIS reports are both noble (research purposes) and mundane (government filing).
The biggest challenge here is designing forms and data capture mechanisms which give better reports, there is usually a big disconnect, where doctors want their templates in one way and expect relevant data to be generated out of it.

5. Custom Designed Templates
Plus91 Softwares have been designed in such a way that we can offer custom templates to doctors. Doctors love this feature, as each one wants to design something as per their understanding and specification. While it gives added power to the doctor, in the long run this feature isn’t ideal for healthcare IT as a growing network as it promotes multiple standards.

On a different note things which we would like doctors to focus on in the future:
a. Clinical Decision Support
b. Computerized Prescriptions
c. SMS/Email alerts and reminders
d. Online EMRs
e. Claims Management

We think these will give a definite boost not only to the quality of service and efficiency of their practice but also in the long run improve profitability.

Improving your Patient Interaction and Outreach

Technology enables, but man disables by not taking advantage of opportunities given to him. A doctor today has many such key touch points to increase and consequently improve their interactions with patients. Some are simple methods, some require a little bit of work, but what is the end advantage of it all? For one thing it makes you popular amongst patients; side effect could lead you to more business. Second it helps educate and provide information to patients and people who may read just what they need thanks to you! A little help goes a long way in accumulating blessings. Third, contributing to the general knowledge resource of the community improves the very community you are part off, it encourages others to follow suit. So now what do you need to do?

1. Reach out to many in the general audience: Start writing, the internet lets you update and express views, either as 160 character bursts on twitter, or a long blog detailing your experience.

Twitter: On twitter you can start putting up bursts of interesting cases you see, new techniques you here about, information about your local medical network which may help people in your area! Go onto www.twitter.com, register yourself and type away.

Blogging: Doing a lot of research which you think people should here about, or have an opinion which potential patients should here about, blog about it. Many people will find it online as they search for an information panacea for their problem and be happy to come across your blog.

2. Letting people contact you: For a start get a website. It helps you disseminate information about your services for people looking for the same. It isn’t advertising, it’s a service, people today face many choices and are hampered by lack of information, improving their ability to find information quickly is beneficial to them. On your website, don’t only talk about you, tell the patients more about what diseases and disabilities you treat, what are the latest treatments, generic advice and maybe even help them going to right person if you weren’t involved.

Use tools like interactive patient forms which can be filled before the patient arrives at the center, saving time and giving you a heads up on the patient’s needs. Use query forms on the website so that people can ask you about their problems, patients their doubts; this gives the feeling to your patients that you are available to them 24/7 without actually being there. Plus91 technologies encourages doctors to have their own websites through their initiative www.websitefordoctors.in, we not only make but also advice and guide you through the process for best impact on your patients and potential clients.

3. Using Software tools: Use softwares which improve communications. Invest in software which doesn’t just keep your records and accounts. The software should come with communications tools integrated and can be used with ease. Emailing of schedules and reports to patients is a must.

The software should also allow using SMSes to send reminders, alerts, prescription reminders etc. This is a new level of service, and patients will be thrilled to know there is always an alert to give them confidence in their moments of doubt.

Online Medical records allow patients to access their records remotely, insist on looking at software which promotes this feature if not today, but at least is compatible with this extension in the future. Plus91 Technologies provides EMR and PMS software products which come coupled with email, SMS and online EMRs. We encourage doctors to use these services to improve their service quality. You can see our products on www.plus91online.com

4. Accessing data and messages on your phone: Today you may be using you phone to send SMSs, read emails and play games online. Why stop there, use it to drive business wherever you are. Neat and simple apps provide you fingertip information, coupled with your own website, or software they can become powerful tools in your hands to handle patients remotely. Access patient alerts via the phone or your actual software to pull up data remotely. Plus91 Technologies already has a suite of products and apps which can run on phone browsers.

5. Contribute to journals and medical website online: Numerous sources are present where doctors submit their stories, research and experiences. The medical and patient community will be greatly benefited by your inputs, a little effort online will show you exactly where you should be adding your data.

6. Using new cool online tools to make education interesting: Nowadays making a presentation, cartoon strip or a cartoon movie to help educate your patients or interested clients is easy. Many tools are available online which let you render very interesting collaterals that can help ease patient doubts and also make it fun. Tools like www.bitstrips.com which we use to make cartoons helps in creating awareness in an educational yet informal way. Putting these up on your clinic facebook page or on your website is the best option.

These are just some pointers on how technology can help you as a doctor to interact with patients and also general public looking for information in your areas of expertise. It’s time to exercise your power using technology, so see you out there soon.

Increasing ROI on your clinic through EMR

Return on Investment is a very savvy term these days with everyone investing in the share market. Doctors too have been on this bandwagon and closer to home they traditionally invest heavily in their clinic and practice. So what do they invest in?

As a Doctor you would invest in a place, interiors, chairs and tables, medical equipment, cabinets, maybe some staff, etc. And the clinic is flourishing and doing well. So what more can be done by you; to increase your return on the investment that has been made? Well one option is by using technology effectively. Off course, this might require an additional investment but it is minuscule compared to the items given above. This can especially be closely tied with two aspects of the practice, increasing base through customer satisfaction and improving efficiency and productivity of the clinic leading to time and money savings. How you ask? Well first we can discuss the usual plus points, then some interesting aspects which tie into the process of the clinic and finally a good example at a radiology setup where EMR can improve ROI.

The usual plus points of an EMR system run something like this:

a. Better Management of Time – All reports and data in one location for easy search and recall, easy patient registration process, quick look up and reference of historical information, easy creation of bills and receipts, MIS reports generated instantly for tracking and decision making

b. Better Management of Space – Less Paper = More space, also less people in the waiting room now that reports are given instantly and appointments are better managed.

c. Better Management of Money – Know where you earn and spend by looking ledger reports across income and expenses, keep track of who refers you more patients, generate reports in Excel, and increase footfalls with better customer service.
d. Better Management of Patients – Integrated SMS and Email features allow you to keep the patient informed, provide reports in double quick time, generate and give old reports instantly, know your patient history before they walk-in.
All the above go a long way in increasing tangible and intangible returns on investment made on your clinic.

So now this was at a very macroscopic level, how about some interesting micro examples?

a. You as a doctor recently invested in a smart phone. A good EMR system will help you make your smart phone clinic smart. Now get SMS alerts about appointments, Emails of reports or images generated by your assistants for you to approve. Use the camera to take images of an X Ray or a Paper report and store it with the EMR instantly, no extra typing required.

b. You invested in an Internet connection, now use the power of the Internet to maximize your business. Imagine an EMR system which allows patients to access their records remotely, no more crowding in the clinic, or sends Email Reports to patient from abroad, may be this can be the start of your very own little medical tourism practice.

c. You recently invested time in creating just the perfect form to help you manage patient history and details so you can improve decision making. Now imagine if this form is a toy, inserting it into an EMR will be like animating the toy, huge return I would say if you were a kid . Use the power of the PC to capture data and display it in forms which help you maximize the benefits of the template you created. Smart little things like auto-completes, graphs, history look ups help managing information better.

d. You invest in staff, trusting them is an integral part of the learning curve. Get the most out of them by making them enter information which is safe and secure in to the EMR system, it is tangible effort. Also they get trained faster in your field using forms and information provided in the EMR system. Our EMR system comes with AV help files which help learning fun and easier. More importantly, save money in terms of possible loss due to the inventory and accounting modules in the EMR system that help you track all inflow and outflow preventing pilferage and stealing. Be on top of your clinic management because after all it is a business.

Now for the Radiology Clinic example I promised:

At a radiology clinic, the entire business revolves around the Sonography machine or X-Ray machine and the reporting system (On paper or on the PC). The doctor has invested in his/her place, interiors, assume a PC (using Microsoft word for reporting), Sonography Machine, along with other fixtures. So how can a EMR system help here?

Well, I am just going to outline a few points here:

1. Many clinics lose patients especially if they are small because of over crowdedness, patients waiting their turn and also for their due reports. Using a good EMR system like Ultrasite from Plus91 would allow them to better manage their appointments and create a good streamlined flow of patients. Also faster and quicker report generation using the EMR system means less waiting time for patients. This ensures that patients do not undergo too much waiting.

2. A good machine generates images, but the imaging and reporting using these images is what creates solid productivity. Using a good EMR system allows you to over time improve your ability to know what size images and how many are required for report generation. Also tools allows you to now directly import or attach images into the patient report, hence minimizing time required to separately print them from the machine. This is also further improved since to access the images you do not need to search for the image and the report separately but they are available at a single location in the EMR system. All this helps to improve the efficiency of the process in using the Sonography machine. It also saves time and indirectly money leading to better ROI.

3. Government rules require each and every sonography machine to be registered and the clinic to generate Forms and Reports for all female sonographies done as per the PNDT Act. This can be long and tedious with doctors investing manpower, time and stationery in creating this. Imagine if you could increase your ROI even on a government dictum. Ultrasite EMR system allows you to generate the PNDT Form Fs and the final report as part of the normal patient reporting and billing process. Save time and resources to invest in other work, increasing ROI. Also strictly followed formats as per the Act and Alerts keep you informed and in check with the Act. Also No Stationery is wasted due to overprinting or spoilage.

4. Radiology centers usually invest in staff due to the nature of their clinical process; now maximize the ROI on this investment, as staffs provide better reports, keep appointments, track referrals and accounts upto date in the software. Reports and MIS generated through the software is good ROI, which would never have been possible on paper.

5. ROI on time? I think almost all the points above lead to better efficiency and time management. So now you can invest this wisely in creating other avenues for growth.

6. And I think the biggest no brainer is for the PC. Most radiology clinics have a PC either being unused or being used to burn, print images or make reports using MS Word. I think to really use the power of the PC an EMR system is a must, in fact not using one is under utilizing a vital resource that you have!

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.

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.

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.

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.

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.

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.

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.

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.

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)