The Physician’s Office of the Future
By Lisa Terry
The gown you wear in the examining room could one day be the only paper you encounter at the doctor’s office, if some futurists’ vision of the physician’s office of the future is realized.
That’s a far cry from the way many practices operate today.
“We have a practice with 35 physicians and a few hundred employees—a $70 million business—and when we deploy their electronic medical records (EMR) we will be replacing 150-plus green screens on a Unix system,” says Mike Jones, CEO at ETG (www.etg.net), a Birmingham, Ala. integrator specializing in physician practices. “Half the users have no mouse, Windows or Internet. Only 12 have e-mail. You could not find another $70 million business in America operating this way.”
The need to reduce medical errors and improve efficiency has already been driving hospitals to catch up in use of technology, a movement beginning to flow out to clinics, physicians’ offices and other healthcare settings. Now the American Recovery and Reinvestment Act (ARRA) and EMRs are adding to the momentum, taking a carrot and stick approach to encouraging physicians’ offices to digitize their patient records.
Many practices will need help—lots of it—to make the transition, first by creating the robust, secure infrastructure required to operate a compliant EMR system. Once that’s in place, these practices can finally take advantage of all of the other technologies that can help them attain their real goals: improving efficiency and quality of care. They’ll need VARs that can offer bulletproof solutions that shield them from complexity and liability.
“Our research indicates EMR bottlenecks will not be in adoption of software, but integrator and integration skill sets,” says Vivian Funkhouser, principal of global healthcare solutions for Motorola Solutions (www.motorola.com).
Technology-enabled Care
While mandates to move to EMR are clear, responses will vary. Some practices will embrace technology, while others will run; one survey found 24 percent of doctors will retire rather than adopt EMR. VARs catering to the physician practice market must bear in mind these mega-trends:
Customer-centricity: Baby boomers will be the biggest senior population ever. As a result, “there will be a lot more competition for patients,” says ETG’s Jones. That means practices will need patient-friendly technologies such as patient portals to let patients self-schedule appointments, get lab results, make payment, and submit scripts to pharmacies automatically. Patients are expected to increasingly take control of their health records and collaborate with clinicians on their own care.
Health Systems: The need to share patient health data and move non-emergencies out of ERs, combined with relaxation of the Stark laws, means hospitals and local doctors and clinics are rapidly forming health systems. In some cases, hospitals will subsidize doctors’ EMR systems and other technologies. The nature of these relationships varies by region; VARs must understand the nuances to determine how and whether prospects choose and fund their own technology. “It’s all very geography based,” says Greg Donovan, president and CEO of Alpheon (www.alpheon.com), a Morrisville, N.C. infrastructure management provider for physicians’ offices, which is transforming to an application delivery provider model.
Healthcare Anywhere: Cost concerns will move some care out of clinical settings and into homes and other settings. Mobility and communications will be critical to facilitate this care. Once EMR is adopted in-office, “the next step is to take electronic records down to mobile devices,” says Jeff Fountaine, healthcare business development manager for Honeywell Scanning & Mobility (www.honeywellaidc.com), though the best form factor for such applications is not yet settled.
Delegation of Care: Some practices (“value-plays”) are increasing use of nurse practitioners and physician assistants to deliver basic care, while the doctor rubber stamps the diagnosis and treatment plan, to increase volume and efficiency. Others (“quality plays”) take the opposite tack, allowing more physician-patient face time. “The care flow really changes when you have a tablet and the chart and everything in real or near-real time,” says Alpheon’s Donovan. Once they’ve been using EMR for a few years, Alpheon’s users average six more minutes per patient. “Going from 11 to 17 minutes is a big deal.”
Office of the Future
Practice style will have a lot to do with technology adoption in the future, and some solutions will catch on while others fizzle. But here are the possibilities.
In the Waiting Room: Check-in kiosks will make that process both faster and more private, and minimize staff data entry of medical history. Kiosks can even help patients triage their own care. Some observers predict patients will carry their own insurance and medical data on USB fobs that could be plugged directly into the kiosk. Kiosks may also need scanners or imagers to collect data from driver’s licenses and insurance cards. Tablets are an alternative form factor for these applications. Some practices will use restaurant-style pagers to alert patients when the doctor is ready to see them.
In the Exam Room: Technology in exam rooms helps doctors check patient history and lab results, record data and assign procedure codes; the challenge is simultaneously maintaining eye contact with the patient. Some docs will opt for hand-held devices while others employ business-class notebooks, tablets or all-in-one desktops. Use of thin client architectures will help ensure data security.
These devices must be handle drops and liquids. “There is a big push for sanitization,” says Greg Davidson, senior business development manager, healthcare, at Panasonic (www.panasonic.com). “There have been studies in hospitals that show 95 percent of cell phones carried by caregivers had traces of MRSA.” Janam (www.janam.com) is set to introduce fully antimicrobial versions of its rugged PDA-style XM series devices, in which not just the housing, but the screen, the screws, and everything else, are treated.
Increasingly doctors will use technology to communicate with patients, using tablets or flat-panel digital signage to explain conditions and treatments and engage the patient in their own care. Features such as multi-touch and HD audio and video enable the multimedia capabilities now being incorporated into some EMRs.
Multi-function printers may be required to create personalized treatment instructions as well as scan documents to convert paper records into digital. Another technology with potential at high-volume practices: sensors in devices such as stethoscopes, thermometers and blood pressure cuffs to automatically and accurately embed readings in EMR systems.
Maintaining the security of patient records is critical throughout the office; security measures such as remote management and Lenovo’s (www.lenovo.com) Trusted Platform Module chip help encrypt data and ensure HIPAA compliance. RF IDeas’ (www.rfideas.com) Exam Room Lock puts sensors in doorways to automatically lock the EMR when the doctor’s contactless smartcard crosses the exit.
In Office Labs: Some estimates put 58 percent of labs in the U.S. within doctors’ offices, a rising trend. Bar code label printing and scanning are critical to ensure accuracy of specimen collection and medication administration, and also improve record labeling.
Lasers are starting to give way to thermal printers such as CognitiveTPG’s (www.cognitivetpg.com) Advantage DLX for labeling patient records, files and lab specimens. Demand is increasing for printers to run standalone applications, such as to encode formulary instructions for a patient’s drug infusion pump into a bar code that can be read by the machine, says Tom Roth, director of printers and media for Intermec (www.intermec.com). Security on printers is also critical, he says.
In Administrative Areas: Wireless will be a critical part of the infrastructure to support proliferating applications: WiFi for communication with devices and integrated communications including Voice over WLAN for applications such as automated reminder calls. Wireless communication of data among systems “decreases errors, and speeds up ordering of meds and labs,” says Brenda McCurry, sales director at ScanSource POS & Barcoding (www.scansource.com). “There is a lot of voice and data that needs to be transmitted.” Wireless broadband will be critical for applications such as virtual consult, says Motorola’s Funkhouser, as an alternative or supplement to T1 lines.
Doctors want to treat patients, not technology. “They want to get out of the business of constantly pouring capital into IT,” says ETG’s Jones. “They want to convert it into services” via utility computing models. Interest in hosted solutions has suddenly spiked among doctors to minimize risk of HIPAA penalties now that enforcement has begun in earnest. Solutions will increasingly include private clouds, virtualization, SAN and use of Citrix.
“We strongly believe there are 10 to 15 product categories that perfectly fit in the cloud, and a bunch of others that for speed, security and legislative purposes need to be run locally,” says Jay McBain, director of Small and Medium Business at Lenovo. Cloud-based apps would include EMR and patient management, while antivirus, e-mail security and the like would have cloud and local components.
Authentication of users is an essential step for privacy; well-designed single sign-on solutions and use of credentials such as contactless smart cards will ensure security while not disrupting workflow. Even group printers will need to be protected to ensure an authorized person is present to immediately pick up sensitive documents, notes Greg Gliniecki, VP of RF IDeas.
Change is Inevitable
Implementation of EMR lays the groundwork to radically alter healthcare in the future; once all records are digital, new frontiers open to exploit that data, as already seen in other industries. Artificial intelligence, for example, will drive evidence-based medicine, where doctors can devise treatment plans on the spot based on statistics about other cases’ outcomes. A follow-on from that concept is a new approach to funding that bases the physician’s reimbursement on outcomes, not procedures.
But those days are still to come. To be sure, many doctors will continue to resist technology, relying on their health system partners whenever possible to facilitate any solutions essential for compliance. But technology-forward practices exist, and physicians will have to change as patient demands, new reimbursement mechanisms and mandates force the issue. “Physicians absolutely will invest in technology that brings real results,” such as improving patient satisfaction, enhancing efficiency or reducing errors, says Harry Lerner, CEO at Janam.
