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.

How technology helps doctors save time!

The basic underline need to incorporate technology and innovation in any field is to increase efficiency and improve accuracy. The same goes for healthcare where non standard processes have lead to an increasingly slow and painful integration of technology into that sphere of business.
However let’s take the case of an everyday Doctor, for this example say Dr. Thakkar. Now Dr. Thakkar is open to technology but is still unsure how exactly it will benefit him. So let’s list down the different applications, instruments and gadgets which can help Dr. Thakkar.
1. A website and Email Id
2. A Mobile Phone
3. A pen drive
4. A laptop or PC with Internet
5. An EMR solution
We have now listed down 6 common everyday solution used by doctors in their daily activities. Now let us go in depth and see how they actually benefit Dr. Thakkar.

1. Website and Email Id:
a. Contact Information with a map is readily available and hence it will save him time and give him peace of mind by not having to talk to his patients on phone about directions and numbers
b. Important information captured on the website: Dr. Thakkar likes each patient to fill in a comprehensive form before he sees them, this causes long lines. Now he can ask his patients to fill this form online and it comes to him as an email which he can read just before the patient comes in. Time saved, more patient seen.
c. Patient across the country or travelling abroad can now easily email their queries to Dr. Thakkar. This can help him provide service remotely to his patient improving his service levels and connectivity with his patients
d. Dr. Thakkar does procedures where he needs to give instructions to his patient for pre-procedure protocols. Often patients forget and keep calling him in the middle of consultations. Now he can re-direct them to his website where it is written down in detail and with proper explanations in multiple languages!

2. Mobile Phone:
a. Dr. Thakkar can now check his daily schedule on a mobile phone. The latest phones come with many calendar features and schedulers with alarms. Also by using Google Calendar or innovative EMR solutions get reminder SMSs on the phone for appointments and operations.
b. Dr. Thakkar will be able to access Email on his GPRS enabled phone which can let him see the latest blood report of his patient and take decisions quickly. All image files of low size can be easily seen on the phone helping him stay in touch with the patients vitals.
c. The latest phones also come with high quality cameras, now store all X-Rays and reports as images at the click on a phone button. Dr. Thakkar can now easily store 3rd party patient X-rays and Usg reports or Lab tests which he can access later on his phone. The latest Emr Solutions allow you to directly attach these images to patient records also!
d. The phone also comes in built these days with GPS navigation systems. Now find your way easily and be on time for the operation. Dr. Thakkar can get where he wants to go quickly and safely, especially if he is doing a house visit to the patient.

3. Pen Drive: A pen drive is a small and low volume file storage system.
a. Dr. Thakkar can carry all his patient report soft copies and word documents in his pen drive, hence he no more lug around a suit case to all the hospitals.
b. Dr. Thakkar can plug his pen drive into any PC and access his notes and presentation on the go. This saves him time in burning CDs or carrying and going through papers. All neat and put into folders.

4. Laptop or PC with Internet
a. Dr. Thakkar can actually maximize the use of all above technology by having his own PC or better still a laptop. Now all his data can be soft copy, easily transferable, viewable, and most importantly searchable with ease!
b. Dr. Thakkar can now access his emails and patient documents quickly and anywhere on his laptop. No need to go searching in the Folder closet.
c. Dr. Thakkar sometimes has queries on new medicines and procedures. Now he doesn’t needn’t wait for the MIMs books or a CME conference, he can simply go onto the internet and search and read about the same information. Why wait when it can all be at your fingertips. Saves time and also treat your patient with the latest knowledge!
d. Dr. Thakkar need not wait for hard copies of patient reports and test results. Now he can have the soft copy emailed to him so he can check them in his office or on his laptop on the move. This saves him time later when he would have to look at all together or make the patient wait for a diagnosis.

5. EMR solution: A software which helps him with his patients and clinic
a. Saves Dr. Thakkar time and improves accuracy in data retrieval of patient reports, statistics on his clinic and medical data, accounts, inventory and even referral management. No time spent auditing or searching in the clinic!
b. Email reports and send SMS reminders to patients and directly from the software to see that you and the patient are up to date on latest developments. Now Dr. Thakkar is always on time and so are his patients. No time spent waiting.
c. Dr. Thakkar likes to send his case reports to fellow doctors and writes to papers and makes presentations. Now he can do it quicker and faster with EMR softwares reports and stats modules. He can also instantly email the report to his associates. No more wasting time on post, fax or even scanning documents.

These are just some inputs on how technology can help you as a doctor get quicker and better on your feet. To know more how we help you with your pain points visit www.plus91.in

Website for Doctors – Looking Back and Looking Ahead

Website for Doctors went live in January 2010, it’s been about 5 months since then and the progress has been fabulous. Some feedback, knowledge, learning and more importantly positive reviews have been taken back in kind from the project. The experience has been wonderful as a lot of doctors and observers commended us on not only the initiative, which serves all stake holders but the quality of work due to the focus shown.
Below is a point wise analysis of the experience:
a. Many doctors show interest in getting a website, but very few actually end up coming through. This is not due to cost but mainly due to the work involved on their side. I think they do not find time or are just plain lazy to send in the information for the site. Also some think of it like a tattoo which once up might define them hence are afraid to put it up unless it’s absolutely perfect so don’t go through with it.
We counter this, by following up with the doctors on a regular basis. Emails, SMS, Calls, the avenues are many, the idea is to not let them slip away once they have the interest. Many have come back to us after 2, 3 months and gone through with the website.
b. Doctors come in different makes, we have the very enthusiastic kind, who send lots of data and information and follow up each day, these are fun to work with, but can take away some of the productivity. We have the uninterested kind, who seem to have decided to make the website as an afterthought and have to be followed up constantly to send data and take decisions, here the site may take long to get done. Similar to the previous kind are the doctors who want the site, but are too busy to make decisions and send in information. Lastly, we have the doctors who send information on time, take decisions quickly and appreciate the effort, and just like good scotch are rare 
c. Few things we noticed that doctors liked were: a. Choice of changing a selected template with some of their own images, b. wanting to display their attachments and timings on the home page, c. Reluctance to elaborate on the kind of work, specialized treatments they provide (personal insight: think they don’t what really to write), d. They love to put up images (a good thing!), e. they definitely need help in deciding a URL, some choose very complicated ones trying to fit all that they do in it, not really useful for SEO.
d. Bottlenecks at W4D: a. Information flow: Doctors don’t send required data on time or take decisions on time delaying the process, which ideally can be completed in less than 2 days for a basic site. b. Sending incorrect information is also high on the list, with numerous errors and mistakes, either it has to be sent back, or time spent on correcting it if it need be. c. Payments: Generally we do not publish the site unless the complete payment is made, hence when doctors’ delay payments we hold the work or do not make the site live, this is a rare case but it does happen. d. Too many changes or close inspection: doctors some times are over critical of their site, I guess from nature of the work they do. This can delay going live which is from the websites need point of view the most important part. I say get it ready, put it up and improve with feedback and time.
So if any of you doctors do want a website, go to www.websitefordoctors.in and send us a request. It takes 3 simple steps and 4 days to have your site up and running. Provided you follow the rules stated above. I think the more doctors are aware of this avenue the more they will promote it amongst their community. You have 3 flexible plans to choose from in terms of cost, complexity and features, so take a decision and take the plunge.
Some stats from our site: we receive nowadays on average 2 website request a day! We have completed over 30 live sites and 15 micro-sites. For some of the more apt key words we are already on the first page. And as for our work check out this video: http://www.youtube.com/watch?v=UAxQ9aW4MzA
What’s been worked on for the future?
• A do it yourself content manager which will let you add information yourself to your site,
• Integration with Plus91 EMR solutions for Online EMR access and pre-visit information capture from patient
• New cool templates on more specialties
• New content which can now be sourced by you on various topics for the site, so no running around
• Patient education videos from PEAS

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.

Single EMR - How far are we?

A unique medical record for each person is considered to be the Holy Grail in the world of healthcare IT – especially when applied to a country like India. When is this going to happen? To begin with a unique medical record would not have to be electronic, but logically speaking it needs to be. A physical record has constraints of sharing and updating, so let’s accept that this unique medical record needs technology to create it. This is a challenge – and a unique opportunity as well, as we do not have any legacy issues; and can piggy back onto the UID initiative started by the Govt of India and spearheaded by Nandan Nilekani.

What will this unique medical record contain? Simple - every piece of your medical history. From your birth, all your medical reports, your changing demographic biological profile, your health information, details about your insurance and your doctors, allergies and medications. It is a time-map of your health, created over time by a range of different people, and owned by you. It will be a combination of your EMR and PHR.

How will this help ? Any doctor you give permission to will be able to see your entire history, thus helping him to make better medical decisions. Today hiring companies and insurance companies are two corporate entities which constantly ask for health check-ups, which means a huge amount of time and money will be saved by giving them permission based access to the required part of the record. For the patients, a continuous record gives them the tool to manage their health better; having a constant record of the test gives a clear indication of what is stable and what is not. Many of us here in India rarely have more than even two previous reports stored properly ! On a much more global scale, statistical and empirical studies on medical data gleaned from these reports provides fodder for research. Predicting disease outbreaks, health hazards, improving living conditions - all require solid data to make proper decisions, all coming from the same source, your medical record. After all – all this data should benefit you !

The challenges to getting a unique medical record are plenty:

a. Lack of technology infrastructure. As PCs get smaller and cheaper (not to mention the entry of ubiquitous smart phones which can compute) and internet penetration scales progressively, this will slowly cease to matter.

b. Lack of cohesiveness in IT solutions . A hundred providers provide a multitude of solutions that look, act and store things differently, so how does one make a unique record, forget about integrating the paper records ? The technology itself is providing an answer , using clever new methods to interface and exchange information.

c. Lack of initiative. Patients and doctors have survived for many years without a unique medical record, and unless appropriate incentives are provided, the situation will remain as it is. Educating the public, providing low cost effective solutions; and providing competitive benefits to those that embrace this technology as early adopters it are a few things that can be done to fast track the change in mindset.

The challenges are vast, but the rewards are too big to not give it a good shot. I think we should also be realistic in what we can achieve. Even once the pieces are in place, entering data for even 10% of the population is going to be a massive task. Also the focus should at first solely be on getting people into the system and capturing all that happens after this point, rather than worrying about the past. The past information can be slowly entered later on. I think we need to move forward, rather than waste time thinking about how to get all the past records of a patient on board.

The ambitious UID scheme only provides the identification mechanism. Now it will be up to healthcare IT firms like Plus91 to integrate this UID mechanism into the software they sell and portals they start, using the UID system to tag each record to a unique person. Over time all providers can then either pool the information or provide access across their databases using this UID. I think a cloud like structure where your record is spread across multiple databases of various providers , but with the same unique tag , is a definite short term possibility. So for you accessing your record using a unique interface will feel like it’s a unique record, but in reality it is but 100 pieces of a jig-saw spread all over the Internet.

This is a challenge – and a huge opportunity !

Website For Doctors - Going great guns...

Website for Doctors is finally live and kicking, and after touching are first 10 clients within the first month of going live, it is safe to say the idea behind the venture is a solid one. Doctors have a business to run and more importantly have information to provide and generate to give high quality service. A website becomes both a handy medium to communicate and a must to garner more business.
So why does website for doctors appeal to the clients who are signing up? Because it is a specialized service, like a boutique hotel or highly specialized clinic, servicing only a certain type of clientele, and specializing in dealing with them, knowing their needs, wants and what is best for them.

Every website completed by us so far has been within 48 hours subject to the doctor providing required information. What’s more important and what we see as a trend is that after the doctor takes the first step of choosing a template and sending his basic data, we have the dummy site sent to him by the next day. Seeing it in the flesh and knowing where this investment is going, doctor’s have been more upto date and innovative in sending their data after this stage. I guess it is truly a question of seeing the believing for them in this case.

Our specialization based galleries, dedicated team and more importantly insightful knowledge from our EMR products is helping us bond with the doctors and give them solutions which suit their needs. A website though standard in most cases, can be tweaked a little and content modified to give the target audience what they need from the website. A consultant exposure to international patients, a small city specialist publicity and directions which his side of the town, a super specialist’s site information about the services and forms which give pre-sight to the doctor before the patient’s actual appointment.

There is still long way to go in actually making websites from a doctor’s point of view, from a “want” to a “need”, but the process has begun, both psychologically and in the ease of getting one tailored to your tastes. Apart from the basic features of a website, there are some simple tools which can go a long way to improve a website experience for a doctor and his patients. Our aim at Website For Doctors is to recommend these tools apart from the normal stuff, these tools include health calculators, video galleries, online forms which can save time at the clinic, Map to the clinic, among other things.

You can check out some of our work at www.websitefordoctors.in
Some of our client sites include: www.ashutoshchaudhari.com, www.swatiallahbadia.com, www.charakchildcare.com

All these websites were ready in double quick time and to the satisfaction of the client. Even today we suggest and take suggestion to tweak and make them better. As Mercedes says “the road to perfection has no finish line” but it definitely gives us and the doctors who have decided to take this journey with us a goal for the future!

Clinkare Demo Video

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.

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.

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.

10 reasons to get a PC for your clinic or practice

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

1. Medico-Legal Protection

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

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


2. Data Security

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

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

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


3. Easy Access to Data

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

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


4. Customer Service

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

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


5. Communication

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

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


6. Save Space!

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

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


7. Generate useful information

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

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


8. Avoid loss and pilferage

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

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


9. Smoothen Operations

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

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


10. Contribute

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

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

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

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.

Cool Applications for a Doctor’s Website

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.