Medico legal and patient safety through information dissemination

Medico legal and patient safety through information dissemination

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My Endo Pune POGS Workshop experience

Watching Doctors peer at the screen seeing surgery take place 1 kilometre away in real time with live interaction with the surgeon made me realise one important thing, these doctors weren’t surprised that they were doing this, which means every one there was comfortable with technology. An improvement from the old mind set of shying away from technology.

So why was Plus91 there? Because POGS (Pune Obstetrics and Gynaecology Society) the organizers of this event were launching their newly developed site (www.pogs.in) by us. We also had acquired ourselves a space to showcase our products.

We displayed our prowess at website design at our allocated desk at the entrance of the makeshift conference room. Makeshift you ask? Well the popular discotheque Scream at Le Meridien in Pune was the scene of the Live Surgery Display. For once I can safely say, if the people at night only knew what was being shown in the morning they would go home shocked :).

Plus91 made its presence felt with a LCD screen displaying our videos and testimonials from the many Doctors for whom we have created websites. Of course our biggest moment came when Pooja and I were felicitated by the POGS President and Mr. Dasgupta the Chief Guest during the inauguration of the new website. I think seeing the society take a positive step in bringing technology into their working many member doctors too felt a comfort level in exploring this avenue of attracting patients and sharing information. We also had a Live Twitter and Facebook update going on. Our pumped up team consisting of Amit, Pooja, Vinay and Shilpi interacted with all the Doctors and also updated their interaction experiences on the social networks.

We also released a new CD entitled “Improve your Life and Work Balance for Doctors”, which has a collection of Books, Articles, Presentations and Videos which tell you how to improve the quality of your Life, being specific to Doctors. The CD was a massive hit and helped Doctors relate to Plus91 as experts in improving their practice.

POGs President Dr. Anand Shinde gave a memorable talk on how the society has help doctors to contribute outside their practice. It shows that the Doctors do a lot of good work in groups and are not individualistic egotists.

The biggest takeaways from the event:
• A good job by our young team of consultants, handling themselves well at the event
• Almost every Doctor present remembers Plus91 as the website experts
• A successful launch of an Association website
• And a nice long list of leads which gives us a chance to create more wonderful websites for doctors!

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.

Do EMRs increase clinic or hospital profits?

What is the most common question asked by Doctors and Hospital Administrators when they meet me? Safe to say it is quote unquote: How does implementing an EMR solution increase my clinic/hospital profit?

Now first let’s go into the economics of the whole thing.

Profit = Revenue – Cost

So to increase profit an EMR needs to either increase revenue or decrease cost, and also factor in its own development, implementation and training costs.
So let us look at revenue first:
A good EMR system can drive revenue up in following ways:

1. Cause: Better customer service
SMS alerts, Quick Generation of reports, No confusion in terms of appointments, neat printed prescriptions, Doctors more attuned to patients with their complete history available, Emailing of reports
Effect: Patients keep coming back to you due to their pleasant experience, they develop a fan following and also recommend relatives and friends thereby driving up revenue.

2. Cause: Better Management of Time
Quicker access to Patient History, More Accurate Appointment schedules, Quicker Generation of Reports, Easy one Click Generation of Management Reports and Statistics
Effect: Man Hours saved by Doctors, Nurses and Attendants can be effectively used to see more patients’ thereby increasing revenue.

3. Cause: Minimizing Errors
Accurate prescriptions, Better Access to History, Improved note taking, Auditing of stored information
Effect: Less time spent on un-doing errors, less chances of revenue loss and time wastage on medico legal cases.

4. Cause: Portability and Access
Online Appointments, Online availability of EMR, Online Access to reports by Doctors, SMS and Email Communications
Effect: Access over the Internet to Patients and Doctors increases work time, provides more avenues for patients to interact with the hospital or clinic thereby potentially increasing revenues. E.g. Charging Patients to access their records online, or Doctors giving reports in quicker due to online access.

5. Cause: Offering More Services
Online EMR, Patient History Printouts, Fast Insurance Clearances, Multiple Doctor Schedules
Effect: New Services offered can be charged increasing the revenue streams

6. Cause: Better Decisions
Unpaid Bills Reports, Daily Registers, Medical and Administration Statistics
Effect: Where is your largest revenue coming from, which service, what kind of patients, which days, answers to all these questions which are now at your fingertips lets you plan better to increase and maximize revenues?

Increasing revenue is just one end of the bargain. The other is saving costs! How?

1. Decrease Staff Size: A good EMR system lets you maximize your efficiency especially on the administrative end. This lets you streamline your staff activities and in some cases even reduce staff.

2. Generating Important Reports: Report on Unpaid bills let you call the requisite clients to follow up and recover the money, a time consuming affair on paper. Or important statistics on schedules lets you find the bottle necks in Doctor Timings and improve the scheduling, decreasing losses to the setup.

3. Save Paper: Less work is done on Paper leading to long term benefits and gains.

4. Save Space: Less paper means less storage space required. Use the clinic and hospitals to provide new services or better service.

5. Manage it all: A good EMR allows you to manage your practice as well, integrating basic accounts and inventory to prevent losses, theft and effective reminders when stocks or balances run low.

Now for the down side, what costs are attached to the EMR?

a. Development: For a customized solution or a product you will spend on developing vis-à-vis buying a ready product, this is the direct sunk cost.

b. Hardware: Choosing a good EMR can greatly reduce this cost, but this too is a sunk cost.

c. Training: Time and effort required in training the staff and migrating to the new system takes time and since time is equal to money there is a cost attached to this.

d. Upgrade and AMC: Support costs are also involved with any software, so is upgrading it to newer versions. But this is vital to pay, because in the long run, PC problems do crop up and its best to be protected.

In the long run however, the ROI on a good EMR system can be tremendous.

Our product case studies for our Clinic Management Software Clinkare showed that a doctor using all the features of Clinkare in a multi-user setup can save upto Rs 15000 per month directly and in man-hour estimates.

But nothing will increase your Profit as much as using all the features of an EMR in a proper manner and fully utilizing its potential. The real value comes when you are ready to work with the EMR and not against it, when you can understand where all it can help you, increased profit is then certain.

Internet Musings with a Doctor

I met a doctor socially the other day, and we had a very interesting conversation about his practice. He has published a website with the help of Plus91 Technology’s Website For Doctor's initiative , and we were discussing the merits of a doctor using the Internet for reaching out to patients.

His first worry was: doesn't this amount to advertising? Because a website is personal digital real estate, he felt this was fine, but was very uncomfortable about using social media to reach out, because he felt this was unethical. I agree that flagrantly advertising and singing praises about yourself may be unethical, but not informing people about your services is also downright unethical ! Imagine a poor patient with a brain tumour who is forced to travel miles in order to talk to a good neurologist , just because the neurologist in his neighborhood doesn't bother to let anyone know about what he does!
Doctors in India are in short supply – don’t they have a responsibility and duty to let people know about their expertise, so that it can be used more efficiently ?

We then started talking about how his website has made a difference to his practice.

a. He now could interact with his patient via the site

b. He could easily give directions to his clinics and his timings by directing people to the site , which had all the information patients needed, including a google map. This saved his patients a lot of time and energy – and his staff did not have to keep on repeating the same directions to all his new patients !

c. The website did convey that he is a serious up-to-date professional, and his patients appreciates this.

Did it get him new patients? The ability of a website to do this depends directly on the web traffic coming to the site, and because his site was fairly new, the numbers were still small, so it was hard to say if this has had a significant impact. If he promotes his website effectively, it is common sense that it is bound to help him attract new patients ! It’s always hard to judge the return on investment ( ROI) on a website , since it takes time for a website to grow ! It needs to be nurtured carefully – and doctors who do this will find this a very cost effective option ! Even one new patient can help him to recover the cost of a year’s hosting ! However, he is reluctant to spend the money to promote his website ( using a search engine optimisation – SEO - firm) , so it’s possible that his website may not help him to grow his practice, making this a self-fulfilling prophecy !

His skepticism arose from the fact that in his experience, when patients search for a doctor, they usually ask a friend or a family member for a recommendation or a referral. Patients may do research online to find out more about the doctor, but not many patients in India today use the internet as a tool to find a doctor. , However , as time goes by, this is likely to change quickly, because many people change cities when they switch jobs; and few have a family physician they can trust. It’s becoming increasingly common for urban Indian patients to use the internet to select a medical specialist to help them get the best medical care.

Social media has a very important role to play, because it is the digital version of “word of mouth” marketing. Let’s take a doctor who specializes in arthroscopic knee surgery. If all his colleagues on twitter, facebook and orkut feeds know about this, they can create a lot of buzz for him. Anytime someone asks these people about knee surgery , they will be sure to say, “Hey , why don't you go in for mini incision surgery and avoid the big scar ? I know a guy who does this and his website is …..”. Here your website becomes a tool which allows others to refer their friends to you easily. If you have videos on your website displaying your surgical skills, as well as patient testimonials, this allows you to build your prospective patient’s confidence in your expertise, and helps to enhance your credibility !

Patient Safety

Few Sundays ago I was privileged enough to be invited by Dr. Nikhil Datar, a pre-eminent gynecologist and medico-legal expert to witness his premier talk on Patient Safety. It was hosted by IMA Dombivali and had a strong audience of over 40 doctors waiting to hear Dr. Datar’s talk. Dr. Datar had recently returned from UK where he attended a program organized by WHO on Patient Safety. Plus91 Technologies believes in making patient centric solutions which don’t just automate the clinic or hospital but also improve quality and service. Keeping this in mind, the presentation was interesting not just for the doctors but also for us.

The doctors were interested in the talk, intrigued by what new information can they hear. It started slowly but filled with practical examples the doctors soon were eager to know more. More than that they realized in their own practice they need to reflect and close loopholes so that they ensure patient safety. The doctors really got involved with questions, interactive cases and videos. I think they all walked out little bit wiser. As a software company involved in Healthcare, I think patient safety becomes a vital cog in what we are doing and it works at multiple levels. 1. Creating solutions which ensure and promote safety, 2. using the patient safety angle to promote such solutions which benefit the doctor in many more ways, but they finally see it as useful when something hard hitting as this is spoken about and 3. Increasing patient interaction and service allowing patients to feel safer and learn on how they should protect themselves too.

So what all does patient safety entail? It covers a lot of ground from something simple like washing your hands before a physical examination to something complicated as giving instructions during a high pressure surgery. They key learning was awareness that things can go wrong and improving communications and processes to prevent minor errors from becoming major issues. Simple techniques like reading medicine names allowed, using color coding on various instruments, storing patient records in a neat and systematic manner help provide better quality care to the patient. I think from hearing his talk, the biggest initiative one can take in improving patient safety is increasing ones awareness in their surroundings. Being aware of the possibility and the effects of your actions goes a long way in preventing mishaps that can happen. Some major inferences were: Out of the 3.7% cases, only 1% could be called as negligent, 50% of these are preventable and most notable – majority of them were not individual failures but the system failures.

I think a lot of good work is now being done in this field by numerous players. The ones which Plus91 Technologies is directly involved with include Dr. Nikhil Datar an epxert in the field, PIET (Patient Information and Education Trust) and NGO, PEAS (Patient Education and Awareness Series) who make wonderful videos and content driven education material, HELP (Healthcare Education Library for People) which have seminars weekly apart from the actual library initiative and Dr. Malpani who is organizing a conference in October in Mumbai exclusively dealing with Patient Safety. As technology pervades healthcare, I can already envision so many places where Plus91 can actively help improve patient safety standards. The possibilities are exciting not only in their scope and challenge but also because this is probably one place we can actually be able to claim we saved a life and that thought gives us a tremendous boost.

Improved Patient Safety Using Software

Patient Safety is a vital aspect of healthcare. With a fairly large number of indirect deaths and also potentially life threatening situations resulting directly from lack patient safety it becomes a vital cog in the healthcare machinery. Software products are introduced in any setup to increase efficiency and accuracy, both important factors when trying to improve safety. I am going to highlight some basic examples how inherently as well by actual design patient safety measures can be improved through normal Electronic Medical Records or Practice Management Software.

1. Prescriptions and Medications: The most common errors are seen when doctors write prescriptions on paper and the patient or the chemist misread the prescription. This is a common occurrence and a printed prescription generated from software with already present Drug Data is the safest bet against such a mishap. Other errors which can be prevented include, mistakes made by doctors in writing the dosage or strength, which in software can be fixed to prevent wrong entries, also a check on concomitant medications interfering the drug can be done. These features are already present in the Plus91 clinic package Clinkare. Ensures no errors happen due to differing writing styles or hand writing.
Another neat feature is sending reminders to the patients/nurses to take the appropriate medication at the correct time via SMS. This ensures no missed dosage which could have lead to problems. This feature is available in ClinION the hospital management solution from Plus91 Technologies.

2. Patient History: Doctors in a hurry, if patient comes without papers can prescribe the wrong treatment in case the data is not properly documented. It is vital to know previous visit experiences which can help the doctor make a better decision. Almost all softwares allow storing overall patient and current complaint history which helps doctors make better and more accurate decisions thus ensuring patient safety. This feature ensures that reliance on memory is less!
In the new age software patient history can also be coupled with Clinical Decision Support systems to help the doctor make his or her decisions in a better and more accurate manner.

3. Patient Data Entry: This is an exclusively software based point. Accurate entry in the system can be ensured by various validation measures and checks. This may slow down the process but a good process ensures the software protects the basic problems that can happen. Some key examples are: a. Validated fields which take only certain values and anything outside throws an error, b. Every time a new page is opened or traversed the patient name is popped up to double check the correct patient data is being filled in, c. Two person check entries at very vital and critical data entry points (used often in clinical trial data management), d. SMS or Email alerts in case of a vital sign going outside normal range at the ICU

4. Consent Checks: A patient must know what procedure they are undergoing, the risks and also most importantly dos and don’ts. A software can for all the procedures ensure that the consents are filled using a reminder / validation system to ensure the patients have been given the once over either by the doctor as a series of questions and answers which are entered in the system or using a video/presentation format with a consent thumbprint or electronic signature taken at the end. This is vital so that the patient does not make mistakes because of not knowing he or she had to come empty stomach for a procedure.
Plus91 softwares automatically allow you to link vital consent forms to various tests, procedures and consultations and remind you to get them filled.

5. Check lists: The Indian Born adviser to the American President on Healthcare issues is Dr. Gawande just released his new book “The Checklist Manifesto”. A checklist is the doctor and hospital staffs most trusted friend. Often negligence cases leading to patient safety mishaps happen because proper procedure was not followed. Many types of software come with check lists which need to be marked as complete before the next screen of tasks can be accessed. This ensures that all important steps are carried out and in order.
Checklists can be determinate that is fixed in nature like an inventory for a particular type of surgery. Some check lists can be flexible, like an in house patient prescription check list or schedule followed for an entire ward. Using software both can be checked and managed without a fuss.

6. Improved analysis: Software allow us to collate all sorts of medical data, this data can now also be analyzed to make future decisions better. Knowing what kind of patients react to which medication, or which months cause more complaints of a particular type of disease or maybe information on which doctors have better recuperation rates vis-à-vis their treatment methods all allow the healthcare system to better prepared for future patients.