Why should physicians play a role in joining this commitment? Health benefits abound that are linked to engagement with the Earth’s natural environment. So do the health risks posed to this environment today by human development.

The good news is, there are some simple ways the 690,000 doctors in the US can take part in the Earth Day celebration to increase environmental awareness of patients and staff alike. Below, I list six Green Acts you–yes, you–can take today.

1. Come out against fracking

Fracking is a controversial method of drilling for oil and natural gas. It involves injecting into the ground deisel products that include toxic chemicals such as benzene, toluene, ethylbenzene, and xylene.

According to the Atlantic, “low levels of exposure to those chemicals can trigger acute effects like headaches, dizziness, and drowsiness, while higher levels of exposure can cause cancer.”

People can be exposed by ingesting chemicals that have spilled and entered drinking water sources, or that were injected directly into underground sources of drinking water by frackers. This method shortsightedly prioritizes profits for oil company stakeholders over our present and future health. That's effed-up, don’t ya think?

2. Buy green and run your practice green

Dr. Joel Kreisberg is the founder of the Teleosis Institute, an organization dedicated to education on greening America’s health-care system. He designed a three-phase program to help doctors who want to not just “do no harm” but also wish to “do more good” when it comes to environmental impact.

Kreisberg suggests practitioners start by taking responsibility for “greening” their surroundings. He says this could include anything: “from recycling paper in the office (pollution prevention), to replacing regular light bulbs with compact fluorescents, (energy conservation), to installing low-flow aerators on showerheads (water conservation).”

You can also lessen your impact by using recycled products in your office in cases where they’re both a) safe and b) available.

3. Support sustainable farms, and buy sustainably-grown food

Buying sustainably grown vegetables and fruits is triply good:

It means that, in growing the crops that end up on your table, day laborers weren’t exposed to pesticide that can cause health problems ranging from birth defects to cancer.

It means that those pesticides won’t be leaching into the groundwater, either, where they could pose risk to people and ecosystems downstream.

And it means you’re getting the health benefits of sustainable crops, which according to food expert Michael Pollan tend to taste better and have more vitamins, minerals, nutrients and flavonoids than conventionally-grown crops.

4. Promote voting to enact laws to combat climate change

Warming can lead to more asthma and respiratory illnesses, exacerbation of chronic conditions, and spread of vector-borne diseases such as dengue fever and Lyme disease.

In 2011 the AMA spoke out after finishing a study on the health issues of climate change. They noted that while climate change is

…hardly a physician-only concern… doctors may find themselves on the front lines in dealing with its serious and immediate problems. Patients are sicker or developing new conditions as a result of changes in the weather. Greater awareness and understanding of the situation, from a medical perspective, is a proper priority.

5. Promote contraception and family planning to slow depletion of natural resources

Mainstream international organizations such as the United Nations Fund for Women note that family planning and a stabilized population would help sustain the planet. They point out that “increasing demand for water is directly related to population growth” and that “lack of access to water is already putting pressure on a third of the world’s population.”

As such, contraceptives can reduce human suffering and illness that can result from overtaxed natural resources. In addition to being effective, contraception makes financial sense as “one of the most cost-effective ways to preserve the environment.”

And as public health measure it moves women toward being empowered decisionmakers, promoting health. Finally, as the UNFPA slogan says it, beyond the environmental impact family planning makes for more welfare of children, “so that every pregnancy is wanted.”

6. Talk up the great outdoors!

People who have spent time in nature will want to protect it if they care about it. Plus, studies show that play outdoors can have positive health benefits ranging from better distance vision to reduced ADHD symptoms to reduced obesity.

The best part about this list? You can make a difference simply by posting on your practice website and sharing these messages on your professional Twitter, Facebook and Google+ feeds.

Have other suggestions for other “Acts of Green” that align with the physician’s role as the healers and health advisors of our society? Please share in the comments section below, or send me an email at katie@softwareadvice.com! Thanks for reading.

Thumbnail image by flickr user Steven Snodgrass

Why Blogging Mothers Matter

Women are the power users of social media and are the directors of healthcare for most families. So it’s no surprise that women–and especially mothers–frequently bring stories about sensitive health issues to the world via the Internet.

“Women are the people who, in bringing health issues to the forefront, are pushing healthcare reform and access while also bringing attention to important issues like maternal mortality,” said Deb Levine.

Levine is a mother of two and founder of the award-winning online sexual health Q&A site Go Ask Alice. She’s also the recent winner of the White House’s challenge to design an app to help prevent dating violence on college campuses.

“A mother will do anything for her children,” added Levine. Given the growing healthcare challenges in this country, that imperative may be part of what’s fueling more women to advocate online for change.

Six Moms Making an Impact

Here are six moms doing important work to better healthcare and the health tools available to themselves and their families–and ultimately, to all of us.

1. Deb Levine – Making access to trustworthy health information easy for young adults

Levine was a pioneer of using the Web to discuss sensitive topics when she created Go Ask Alice in 1993, arguably designating it the “first major health Q&A Internet site."The site provides a Q&A on sexual and other health and emotional challenges facing college-aged kids. It was named by Stanford as the most accurate reproductive health information resource on the Web, and today over 1.5 million people visit Go Ask Alice each month. Levine’s work has made clear that “topics considered to be shameful and embarrassing like sex are best discussed behind a screen–computer screen then, mobile phone and PDA today.” Levine directs Internet Sexuality Information Services, a nonprofit, and will host a conference next month on new media, youth, and sexual health.

2. Elita Kalma – Sharing information with women of color on the importance of breastfeeding

Kalma, a librarian, started her blog, Blacktating, after searching for information on breastfeeding online and realizing few moms of color were being heard in the conversation. Kalma shares information and recounts her own story to help other mothers realize breastfeeding is one of the ways to counter child obesity and can also make children better off on a range of other health issues; since according to the Surgeon General breastfeeding rates are about 50% lower among black children at birth compared with white children, Kalma’s role as a role model and an informed guide for the black community is a critically important one. She recently weighed in on the importance of Beyonce’s choice to breastfeed for the black community because of their lower initiation rates, and also called out the major news sources which completely failed to mention the event’s racial significance, which had sparked an hours-long conversation on black Twitter about breastfeeding.

3. Jodi Jacobson – Advocating for public health and reproductive and sexual health and justice

Jacobson, the Editor-in-Chief at RH Reality Check, is a leading voice in monitoring and promoting accountability to women’s reproductive and sexual health and rights. She’s partially responsible for publicizing the Susan G. Komen Foundation’s policy change last month that, had it not been reversed, would have denied preventative health services to thousands of women. She’s been quoted extensively in the Lancet as well as The Economist, illustrating her influence on both medical and mainstream thought leaders. Jacobson founded and led the Center for Health and Gender Equity, an internationally-influential organization producing “cutting-edge research on international policies and programs” as well as a “leading source of information and advocacy for international and domestic movements, academics, program managers and the media.”

4. Robin Strongin – Eliminating “gatekeepers” to drive disruptive change in the health sphere

Strongin’s blog, Disruptive Women in Health Care, has been around since 2008. It serves as a platform for “provocative ideas, thoughts, and solutions in health,” recognizing that the industry needed a push from some outsiders to advance the pace of change. The women posting on her blog highlight underreported issues such as food allergies in children; the importance of better incentives for mobile health in the U.S.; and the surprising shortage of primary care physicians accepting new patients. By “disrupting the health care status quo,” the blog aims to amplify the voices of its bold women contributors through its coverage in important media outlets including CBS, The Hill's Healthwatch and mHIMSS.

5. Penelope Trunk – Creating dialogue around miscarriage and health issues working women face

Trunk, who has two young children, blogs about “the intersection between work and life.” She inadvertently caused a media uproar when ABC, CNN and AOL covered her tweet about her own miscarriage. The attention brought to this story created mainstream discussion about the misplaced shame sometimes associated with discussing health issues. Trunk wrote poignantly about the misconceptions around miscarriage by defending her choice to discuss the event with revealing statistics:

Most miscarriages happen at work.Twenty-five percent of pregnancies end in miscarriage. Seventy-five percent of women who are of child-bearing age are working. Most miscarriages run their course over weeks. Even if you are someone who wanted the baby and are devastated by the loss, you're not going to sit in bed for weeks. You are going to pick up your life and get back to it, which includes going back to work. This means that there are thousands of miscarriages in progress, at work, on any given day. That we don't acknowledge this is absurd. That it is such a common occurrence and no one thinks it's okay to talk about is terrible for women."

6. Mary Brune – Connecting mothers to information about toxic environmental risks

MOMS–which stands for “Making Our Milk Safe”–is the site Brune founded to act as a national grassroots movement for mothers to collaborate for a healthier and safer environment for their children. The group is partly an advocacy organization keeping environmental health regulators in-line, and partly an online resource to publicize information about risks and protection measures. PBS featured MOMS as a resource in a piece on toxic toys. Visitors to the MOMS site can sign up to receive a newsletter regular updates about contaminants and risks, as well as steps parents can take to protect their children.

Collaboration may be the next important step for these women and others like them. “Those doing work around health issues must band together to become an advocacy movement,” said Levine.

Please share your thoughts on what I’ve said about the role moms play in using Internet tools to advocate for better health care by commenting below, or email me at katie@softwareadvice.com.

Thumbnail image created by: Robert Whitehead

Based on observations made as more practices have transitioned to EHRs, billing service providers should view the EHR as an ally, not a threat. EHR-related assistance services represent a lucrative opportunity for billing services to generate new revenue streams while strengthening ties to their medical practice clients.

Here are five steps billing service companies should take to seize that opportunity.

1. Know What EHRs Don’t Offer

Rather than looking fearfully at EHRs, educate yourself. If a doctor hints that she’s thinking of phasing out your services, be prepared to talk to her about what her EHR can’t do.

Even if the EHR has some sophisticated billing features, ask: Can the EHR make collection calls? Arrange for payment plans from patients? Obtain correct supporting documents? Identify opportunities for upcoding? Make follow-ups?

“The reality is that the software doesn’t replace you at all,” said Ian Gary, senior national salesman at EHR vendor HealthFusion who discussed the topic with me at length.

2. Know What You Can Offer

After you establish that some parts of medical billing can only be done by a well-trained human being, the next step is to communicate to your clients that your team is in the ideal position to help them with their EHR transition. Your employees are most likely already well-versed in how their EHR system works since many billing services work with multiple EHR vendors.

Moreover, who better to advise a practice than the company that is already familiar with their diagnostic codes, terminology and pain points? As Steven Tolle, Vice President of Solutions Management at EHR vendor Allscripts said in an article on the topic, “[Third-party billing companies] have the trust of physicians, and you can leverage that to expand your business.”

3. Extend Your Services

There are a variety of EHR-related value-added services you can offer clients, including:

• On-site support on the medical practice's "go live" date–a service many EHR vendors don't offer
• EHR template customization assistance
• Ongoing on-call EHR troubleshooting support

You might also consider different models for how you deliver services. For example, Gary mentioned that, particularly for small-town practices, people may be wary of learning about their software from “just a voice on the phone,” preferring to do business “with people they’re going to see in church on Sunday.” Offering on-site training may be far more appealing for these doctors than the virtual training provided by many EHR vendors–especially if you have team members based near their location.

4. Emphasize the Convenience and Personalization You Offer

Doctors outsource billing to service providers like you because they can make more money treating patients than doing paperwork. The same logic goes for tweaking their EHR systems. That’s where you come in. Find ways to save doctors time and trouble, allowing them to focus on patient care. Offer to build them templates that will feel intuitive and natural, and tailored to their practice needs. Program their most common diagnostic codes. Do whatever it takes to make their lives easier, and they’ll be happy to cut you a check.

5. Know You’re Strengthening Client Relationships

In addition to generating extra income, billing services that provide extra value to doctors are differentiating themselves and are making it less compelling for a practice to switch to a different billing service. If it takes some time to set the systems in place, keep in mind that the work will pay off later.

Thanks for reading, and please feel free to share in the comments section below any thoughts you have on something I’ve missed in this discussion!

Thumbnail photo credit: Flick user AMagill

One strategy is to get on Google+, the search giant’s new social network. Using Google+ is an easy, quick and free way to improve the likelihood your name will come up when people are searching for topics related to your specialty. This article outlines the benefits of Google+ for doctors and how to get started.

Google+ Makes It Easier for Patients to Find You

Google+ can help you “get found” because content shared on Google+ is favored in searches made using Google’s search engine–and Google controls 66% of the search engine market.

For example, if a doctor writes a post about back pain and shares it via Google+, Google will favor this post in search results for topics related to back pain over comparable results not linked to a Google+ user. That’s important, because the higher up your content appears in search results, the more likely it is someone will visit your site.

In the example below, when I searched for “causes of fatigue,” the first article to appear was authored by a doctor with a Google+ profile. When I clicked his name, I discovered he is in Austin, where I live. Had I been looking for a local doctor to treat fatigue symptoms, Google+ would have helped me find him.

This effect is multiplied across your Google+ network over time. Search marketing expert Brian Whalley explains:

[As you build up] a large following on Google+, content you've shared with your followers will also show up in those followers' relevant Google.com searches, keeping your business top of mind and increasing its visibility among existing followers across multiple channels.

Google+ also helps you stand out due to the social data that Google+ provides in search results, which imparts trust in your content and makes searchers more likely to click it. This can include a headshot of the author (you), a link to your Google+ profile, the number of people in your circles, and the number of people who have +1’d (liked) your content. Consider this guide to Google+ by technology journalist Ben Parr. This is the top result when I search for “google+ for doctors:”

Knowing the size of an author’s network and the popularity of his article signals useful information on how authoritative a person is and how helpful others have found his writing.

Of course, unlike tech bloggers, most doctors don’t spend hours writing content or growing their online networks, so few have the kind of online reputation Parr enjoys. But establishing yourself as a trusted medical expert is only going to become more important over time. The cost of care is rising and patients often don’t view distance as a deal breaker if it means better treatment at lower cost. Where will patients head to find the best care out there? More than likely, to the Web.

How to Google+: 5 Steps to Starting Today

Ready to get started with Google+? It’s easy. Here are the basic steps.

1) Set up a Google+ page and create an account. Choose between building an organization page (e.g., Austin Medical Group) or personal page (e.g., Frank Smith, MD). We recommend doing both.

2) Fill out basic biographical info.

3) Ensure that keywords that describe you appear in key areas of your bio: Introduction, Employment, and Places. This will help you “appear” when people do a search for a doctor like you.

Many doctors whose profiles I’ve seen chose to write several paragraphs in the Introduction section. Reference Dr. Howard Luks’s or Dr. William C. Shiel’s profile as examples. Be sure to include the most common words for your specialty (e.g., eye doctor, eye specialist, optometrist) and be sure to mention your location (e.g. Austin, Texas).

4) Link your Google+ page to your website. There are two ways to do this. You can add your name and email to your website or blog content (recommended for sites with content by multiple authors). Or, you can link your website or blog content to your Google Profile, and vice versa.

This step is necessary to prove to Google that you are the owner of the site you claim is yours or are the author of the article you claim you wrote. Also, it paves the way for your image showing up next to stories you’ve shared (which requires you have a certain number of people in your circles).

5) Participate strategically. I’ve written another post that helps you determine what to share on social networks. But here’s some additional advice specific to G+:

• Grow your circles of people you follow, and who follow you. Search for, and follow, peers and leaders in your field. Re-share their posts and comment on them, and chances are they’ll follow you back.
• Keep boundaries intact. Physician and social media expert Kevin MD has done a good job of explaining the settings in Google+ that help you separate personal and professional contacts.

Still want to learn more about G+? Take a look at this article by Social Media Examiner. Good luck! And if you have any comments on anything you think I’ve missed, please feel free to share in the section below.

Regina Holliday – The Patient Rights Advocate

What she does: Regina Holliday advocates for patient rights through art. Inspired by her late husband’s struggle to get appropriate care for kidney cancer, her paintings are designed to provoke thought about the meaning behind changes in the world of health IT. One of her most discussed paintings, “The Menu Set," reflects her thoughts on the Meaningful Use (MU) requirements that doctors must meet to qualify for HITECH Act federal grants. While providers may see these requirements as just another hurdle, Holliday thinks MU requirements have the potential to transform patient treatment. She captures this well in her painting. Why you should know about her: Holliday is known to voice her message at places ranging from the HIMSS12 conference, where she’ll be a keynote speaker, to TEDMED, where she’ll be an on-site artist. An advocate for clear, transparent electronic health records (EHRs) that patients can access and take with them wherever they must, Holliday reminds us: “Timely access to personal health information can make all the difference to patients throughout the world…. the game is not about money. It is about life and death.”

Judith Faulkner – The Old Guard

What she does: In 1979 Faulkner launched the company that eventually became Epic Systems. Epic not only introduced the industry’s first Windows-based EHR, they’re also responsible for developing one of the first web-based health IT systems and one of the first personal health records, MyHealth. Epic is used by Kaiser Permanente, the largest non-governmental health care provider in the country. All this was accomplished with Faulkner firmly in the driver’s seat: she’s still involved in any major company decision. Why you should know about her: With a seat on President Obama’s Health Information Technology Policy Committee, Faulkner appears poised to expand her influence. For example, her company is in the running for a contract for a massive expansion of the Veterans Administration’s electronic health record system. She does generate some controversy, however, because of her lack of support for multi-vendor interoperability.

Susannah Fox – The Thought Leader

What she does: As the Pew Internet Project's Researcher on Health and Health Care, Susannah Fox studies the cultural shifts taking place at the intersection of technology, health and the information highway. For example, thanks to her, we know that 13 percent of adults have gone online to find other people who might have health concerns similar to theirs, and that those living with chronic and rare conditions are significantly more likely to do this. Why you should know about her: Fox blogs regularly on e-Patients.net and is helping researchers understand the habits of patients so that health IT can better support them. A recent, thought-provoking comment from her blog illuminates her role as a visionary: “What if, instead of running clinical trials on patients, scientists ran trials with patients?”

Halle Tecco – The Incubator

What she does: Tecco co-founded Rock Health, a seed accelerator “powering the future of the digital health ecosystem” by providing capital and mentorship to health startups. Launched just last year, Rock Health has drawn funding from Microsoft, Qualcomm, Quest Diagnostics and Genentech. Two of its first class of graduates have already drawn additional funding from investors. Why you should know about her: Tecco should be inspiration to those who might not have a strong background in health but still want to get involved in health IT. She had roles at Apple and Intel prior to attending Harvard Business School, where she met Rock Health’s co-founder, Nate Gross. Her organization, too, aims to bring in developers and programmers–who may or may not have had a background in health– to encourage new thinking about health care. Rock Health has a solid group of advisers involved, including the CEO of Sermo, and representatives from Twitter, 23andMe, HealthTap, and the Mayo Clinic, among others.

Amy Sheng – The Innovator

What she does: Amy Sheng and Erik Douglas met in a lab working on mobile microscopy for the developing world. In 2010 they formed CellScope, Inc. to apply the technology to home use in Europe and the United States. CellScope–supported through Rock Health (see above)–uses optical attachments that turn smartphones into diagnostic-quality imaging systems, letting consumers bring “expert diagnosis and advice into low-resource settings.” Why you should know about her: CellScope is available for use in village clinics in the developing world and households in the developed world. It demonstrates the great potential for telehealth solutions to break down the barriers separating developing countries from high quality health care. Have I left anyone important off the list? Please email me at katie@softwareadvice.com or leave a comment below. If I get enough additional nominees I’ll do a follow-up to this post in a few weeks. Thanks for reading! Thumbnail image source: Wikimedia Commons via Rei-Artur

Disease Risk Calculator

The device: Proteins found in blood can be used as biomarkers to diagnose diseases from type 2 diabetes, to cancer, to HIV. Using tests that detect specific biomarkers of diseases long before clinical symptoms arise can lead to earlier treatment, saving lives. The tests can also be used to assess risk of disease, by calculating not just the presence of biomarkers but also their concentrations. Information on disease risk can help people correct course during early stages rather than allowing the condition to worsen unchecked.

The benefits: Based on social norms theory, showing data about some lifestyle diseases such as diabetes –alongside what healthy protein levels should be–could go beyond just informing patients about their health. For example, if a patient who does not yet know he is prediabetic sees his biomarker data displayed alongside average data from a healthy individual, this visual could serve as an “intervention” to correct his mistaken assumption that he’s healthy.

An interface that told a patient how his score had changed over time could help him visualize progress. It could also track patient activities that can reduce diabetes risk–such as regular exercise and a healthy diet–alongside progress to show the patient visually that the steps he’s taking does have consequences.

Spirometer

The device: Studies have found that measuring breathing difficulty before and after taking medicines for emphysema or chronic bronchitis can help people minimize shortness of breath. Often even after a patient has taken a medicine that does increase airflow to the lungs, their shortness of breath continues. But if a patient sees the measurement of her inspiratory flow–her in-breath–before she takes a medicine, the likelihood she’ll actually start breathing easier after she takes the medicine will be increased.

Today, the kinds of spirometers owned by patients are cheap, simple devices, so there could be enormous value in an app that could record a patient’s breathing performance over time and even attach notes like “pre-inhaler results” and “post-inhaler results.” Spirometers in medical offices monitor this at present, but patient-owned devices do not. Tracking the results over time is extremely useful for both patients and doctors.

The benefits: 3.5 percent of ER visits each year are primarily because of shortness of breath, so giving people with the right medicine a simple way to better control the symptoms of the disease on their own can help people feel more in control of their disease and reduce load and cost related to ER visits.

Electrocardiogram

The device: Interpreting the electrical activity of the heart over time is useful. It can tell you the rate and regularity of your heartbeats, as well as the size and position of your heart chambers. The presence of heart damage, as well as the impact of drugs or heart rate regulation devices such as pacemakers, can also be detected from an ECG. We wrote about a minimalist iPhone version of the ECG last week, but this one’s the real thing. We anticipate an app will be able to not only take readings from ten electrodes attached to the body, as is standard with traditional standalone ECGs today, but will also be able to alert users to possible heart health problems.

The benefits: If used by caregivers this device can help automate recognition of possible problems, rather than relying solely on the human eye to detect potential regularities. This can reduce errors of ineptitude discussed by Dr. Atul Gawande, who proposed making checklists for doctors the standard to reduce the accidental oversights that plague medicine today. Though a layperson wouldn’t necessarily be qualified to know how to correctly position the electrodes to ensure a proper reading, the app could also help walk the caregiver or nurse through the procedure as a safety check to standard training, leading to lower risk of error. In addition, doctors could take this device to the field.

Since we already predicted exponential growth of this area of health innovation in the last post, we won’t do it again. We’d welcome comments below–particularly from experts in both biomedical technology and in app development–on the feasibility and future of these devices. Thanks for reading!

Thanks to Russel Pryor for the great drawings, and to Dave Wolpert, Charlie Matlack and David Mendosa for their insight on this piece. For more on new media medicine, check out MIT’s New Media Medicine Lab's projects. You should also follow the conversation on helping patients play a more active role in their own health as it unfolds at ePatients.net.

1. Handles Large Image Files Efficiently

Since ophthalmologists frequently work with high-resolution images of the eye, you’ll want the ability to quickly access and scroll through large image files. A range of options exist for accessing these files in a way that doesn’t slow down the rest of the system.

“Images take up a lot of space on the server, so my images are run off a second server,” said Dr. Dean Carlson of Eye Associates of Colorado Springs. Dr. Carlson uses a solution from SRS.

Dr. Valla Djafari of the Texas Retina Institute works out of multiple offices, and noted that his Web-based EMR system allows him to get on the wireless network of whatever office he’s working from to easily access the files he needs.

2. Connects to Devices Used to Measure Eyesight

Getting data into your EMR directly from your testing equipment, such as your visual field units and cameras, can save you from “having to go hunting and pecking all over” for that data, in the words of Dr. Byron Tabbut of Wheaton Eye Clinic. Saving time is essential for Dr. Tabbut’s practice, which has 130,000 patient visits a year.

“You should be able to integrate your digital media to the platform you’re using, so you can have all your information available from one source,” he said. Dr. Tabbut also noted that HL7 and Dicom are emerging as the standard formats to facilitate sharing of data and images, respectively, across systems.

Dr. Walter Harris of Rittenhouse Eye Associates–who is on the hunt for a system and has narrowed down his shortlist of 20 vendors to three semi-finalists–had a useful tip related to pricing for testing equipment integration:

“It’s worth the money for a system to be able to intersect with your testing equipment. But different companies will charge differently for this ability; one might offer an unlimited option, while others might charge you per piece of equipment.”

As such, Dr. Harris recommends asking each vendor about the pricing structure of the feature. He also suggested having a list of all your exam equipment in hand when you meet with vendors.

3. Allows Access to Key Patient Data and History

Having quick and easy access to key elements of a patient’s historical health information–particularly a patient’s historical intraocular pressure–enables ophthalmologists to make more informed treatment decisions on a case-by-case basis.

“Some EMRs can trend intraocular data for you, so you know what the safe levels are for each patient,” said Dr. Tabbut, who also uses an EMR from SRS.

Tracking how a patient’s eye health responded to medications is also useful for ophthalmologists. According to Frank Bellocchio, the Ophthalmic Technician with Dr. Harris, systems that display the average intraocular pressure of a patient together with historical medication data help you make diagnoses and develop treatment plans.

4. Has Long-Term Vendor Sustainability

Dr. Harris shared with me a key takeaway he obtained from a recent annual meeting of the Academy of Ophthalmology, where a German ophthalmologist had advised his U.S. peers about what to look for in an EMR. Germany began switching to EMRs about 10 years ago, and lessons learned from their experience are applicable to ophthalmologists in the United States today.

As Dr. Harris explains, “Ten years ago in Germany, there were 67 EMR vendors for ophthalmologists. Today, there are six. Half of the practices that bought an EMR had to buy one again, or twice.”

His advice: “Look for a company with a commitment to ophthalmology, not one that might close up a few years out.” He suggests looking for vendors with at least 10 years of ophthalmology experience, to find ones that would be the most knowledgeable and time-tested.

I hope you’ve found these tips helpful. One final suggestion: don’t settle. There are solutions out there that can help you provide better care, improve your patient load, and get home earlier. If you have comments or I’ve left something out, please feel free to share a comment in the space below. Thanks for reading!

Thumbnail photo credit: Flickr user _StaR_DusT_. 

The processing power, big color screen and touchscreen interface allows these iOS devices to provide the core computing platform necessary for many diagnostic devices. We expect the market for iOS-based medical devices to explode in the near future as new apps and extensions are designed and developed. These devices will prove useful in the clinic, and at home as patients with iOS devices take a more active role in their own care.

“[Thanks to the iPhone] suddenly everyone has a medical device in their pocket,” said Sean Mehra of HealthTap, an interactive community of patients and physicians exchanging personalized health care information.

Below we present five beautiful iOS medical devices that are on the market today or nearly there. And next week, I’ll follow up with a post with three ideas for medical peripherals that are further off in the future, but that I think will be valuable for the physician, the caregiver, and the engaged patient.

1. iBGStar Glucose Meter

Over 17 million Americans have diabetes, but today most use needles and a clunky kit to check blood sugar three times a day. With an iPhone compatible-glucose meter, diabetics can collect, track and share blood sugar data easily. The iBGStar glucose meter by Sanofi-Aventis is said to be more accurate than standalone glucose meters. A case can be fitted around the meter and phone, making them one unit and essentially just extending the length of the phone a bit. Your phone can also be programmed to remind you when it’s time to check levels.

2. iPhoneECG Electrocardiogram

This clever design incorporates electrocardiogram (ECG) electrodes right into an iPhone case, which then transmits data to the iPhone when you press the device to your chest. The combination turns your phone into an ECG, the iPhonECG, developed by Alivecor and Oregon Scientific. It costs around $100, including the app. While it doesn’t yet get granular enough to replace a complete ECG–which gathers data from ten electrodes, not just two–it can be a useful tool for a quick diagnostic or for patients eager to take an active interest in their health.

3. Withings Blood Pressure Monitor

This monitor measures systolic and diastolic blood pressure and pulse rate with an inflatable cuff. It can help users monitor hypertension, which can cause hardening of the arteries and lead to heart, brain and kidney damage. French tech company Withings created a plug-and-play solution that’s compatible with an iPhone, iPad or iPod Touch. Its price tag of $129 includes the inflatable cuff, which runs off standard batteries. The app will alert users to unhealthy blood pressure ranges and can be set up to email results to your doctor.

4. ECEM Pulse Oximeter

Monitor the oxygenation of hemoglobin in a person’s blood stream with this peripheral, which will be of particular use to patients with heart or lung problems such as emphysema. A small clip attaches to the patient’s fingertip and beams a light through the tissue to a receiver. The light received is translated into a percentage of oxygen saturation of the blood. The Electrical and Computer Engineering in Medicine research group in collaboration with the Pediatric Anesthesia Research Team at the University of British Columbia developed the Phone Oximeter. It comes with decision support software too (and has a sweet promo video well worth watching).

Bonus: The device can make anesthesia care safer throughout the developing world, where death rates from anesthesia are 100 to 1,000 times higher than in developed countries.

5. MobiUS SP1 Ultrasound Imaging Device

Watch your little one grow day by day with your own personal ultrasound; rural doctors and home care givers can benefit from the extreme portability of this peripheral compared to the standalone machine, and will certainly enjoy its lower price–$7,495. Wi-Fi and cell connectivity means images can be shared quickly. Captured images are small enough for mobile usage but smaller than those captured through traditional ultrasound machines. Unfortunately, Mobisante’s device doesn’t run on iOS yet. But we thought it was so cool, we had to include it and hold our breath waiting for an iOS version.

If you found this post intriguing, wait for a coming post, where I'll discuss three more devices I dreamed up with the help of Russel Pryor, our graphic designer. Meanwhile, I'd sincerely appreciate hearing your comments on this post–please feel free to share in the space below. Thanks!

To find out, I spoke with representatives of three healthcare organizations where EMRs are in place:

• Ian Kornbluth, Licensed Physical Therapist and owner of Neurac Institute and Therapy Solutions, two private practices in New Jersey.
• Hal Daugherty, Practice Administrator at Mobile Heart Specialists, a five-physician cardiology practice, in Mobile, Alabama.
• Jeanette Christopher, Information System Teams Leader; Amanda Trujillo, Quality Management, Site Manager, EHR Implementation Chair; and, Samantha Walker, Medical Records Team Leader, at Northwest Primary Care Group, a 26-physician group in Portland, Oregon.

Here are eight pieces of advice they shared with me.

1. Get Input From Your Doctors

Before you commit to switching to a particular EMR, secure buy-in from the doctors on your team. How? Solicit feedback on features they want in their EMR. Ask what’s important to them about the system they will use. In the experience of Northwest Primary Care Group in Oregon, the benefits of asking for this input were twofold. It helped them narrow-down what EMRs to even consider. And when they were later in the midst of transitioning, their doctors were on-board because the change was something that they themselves had asked for.

2. Define Who Makes Final Decisions for Your Team

While getting everyone’s input is key for garnering full support for your transition, it’s equally important to define a clear leader of the process. After the group weighs in, this leader will have the final say. The team at Northwest, whose Medical Director played this role, stressed this point. As they explained, “The doctors knew our Medical Director listened to their input, but also knew that the final decision was up to him, and they defer to him.” The takeaway? Spell out who has the final say in advance, and you’ll neutralize time-consuming power struggles and hair-splitting debates before they arise.

3. Sweat the Product Details (Then Get Them in Writing)

Before committing to buy EMR software, hammer out the details of your vendor agreement. This tip came from Hal, a practice administrator of a five-physician cardiologist group converting to a full practice management and clinicals suite. Hal, who ended up working with Oberon Medical Solutions, stressed the importance of clarifying with any vendor which modules and product versions will be included in your system. Another transaction-related tip from Hal: discuss–and get in writing–a description of responsibility for your data. If your software provider goes under, you’ll want to ensure you’ll still be guaranteed access (for further discussion on this topic check out this post by my friend Mike over at ECLIPSE).

4. Get Software For Your Specialty (or Plan to Customize)

Everyone I spoke with highlighted the importance of choosing a system that fits your specialty or can be easily customized to fit your practice’s needs. After all, the extent to which an EMR fits your practice will determine how much time your system will allow you to save. The Northwest team uses Vitera, a product flexible enough so a system administrator can make any changes a doctor requests within an hour. By contrast, Ian Kornbluth uses a specialty-specific solution.“The software I use, WebPT,” said Kornbluth, “was built by physical therapists, for physical therapists. Our transition process was pretty easy and painless.”

5. Phase In Hardware Ahead of Software

Learning new software can be daunting. Now imagine trying to do it while not knowing how to work a computer. For some doctors who’re new to computers, the basics of how to access files, join wireless networks, or respond to a frozen screen increases the new technology learning curve. And doctors hate to fumble in front of patients, since this might give patients misgivings about their abilities in other areas (like medicine). That’s why the Northwest team gave their doctors several months to practice at home on the specific computers they’d be using at work.

6. Have a Capable Team Create Your Records

In a paper-based office, each time a patient visits the practice there are lots of new forms to fill out. But with EMRs, you fill out a patient’s basic information just once. That places extra importance on getting the data in perfectly the first time. As Kornbluth did, you might have one staffer responsible for entering patient data and another there to check the data is accurate. It’s also important a qualified team is scanning in your documents when you’re creating those records. The team in Oregon has their regular staff members handle scanning, stressing that only staff with highly specialized training would know where to store information from a paper chart within the new record.

7. Be Systematic About Scanning Documents and Phasing-In EMR Use

Practices typically set a date to start using their EMR with active patient files. This usually means that after that date, patients have their files entered into the EMR as they come in. Most files are created through a combination of manually-entered data and scanned files accessible through the EMR. Your phase-in process might mean doctors use paper charts during patient consultations while nurses later input information from those charts into the EMR. So you’ll need to agree on a practice-wide way you’ll denote what has already been captured in your EMR and what hasn’t. A low-tech way to track what’s been scanned: “We put a diagonal line in highlighter across the front and back of sheets after they had been scanned into a patient record,” said the team in Oregon.

8. Involve Your Patients in the Switch

Patients are likely to be pleased about a system that can free up more time for you to spend with them. They’ll probably also be happy to hear an EMR can help you provide better care. It’s a definite marketing benefit if you get the right information to your patients–just be sure you tell them how their data will be secured, since one of the biggest patient concerns related to EMRs is data security. Finally, it’s also worth planning for how the new system will impact the way your doctors interact with patients. Will doctors need to turn their back to them or look away to use the EMR? Try to set up your machine so it doesn’t interfere with doctor-patient interactions.

Whatever your reason for deciding to switch, I hope you find these tips helpful. Let me know if I’ve left anything out by leaving a comment below. Thanks!

Photo credit: Flickr user @alviseni. 

Patients looking for a new doctor often look to the web to find practitioners in the city and specialty they need. So, participating in networks like LinkedIn and Facebook enhances a doctor’s visibility with potential patients.

Moreover, social media can help doctors provide better care, suggests one study discussed in peer-reviewed Chest Journal. It found that patients who hear from their doctor after their consultation are more likely to take their meds properly and follow the doctor’s advice. It also found that patient-doctor communication after the appointment improved patient satisfaction and retention.

Another use for social media? Education. As the New England Journal of Medicine reported, doctors often find themselves correcting patients who believe anything they read on the Internet. Physicians can use social media channels to combat quack claims.

One specialist with a strong Twitter and Facebook presence is Dr. Howard Luks. In a 2010 interview with ABC, he said the physician’s role is becoming that of a leader “helping the engaged and interested patient navigate the Internet.”

Ready to be social, then? Here’s the key: If you know your target audience and its habits, then you’ll be in a better position to reach them successfully.

Step 1: Make Sure Your Patients Actually Use Social Media

I spoke with a few doctor friends for this article. Those who treated older or impoverished populations who didn’t regularly access the Internet said social media was less relevant to them. But, they all hastened to add they were sure it could be useful for colleagues whose patients were active on social networks. For example, one suggested young mothers could benefit from a physician’s Twitter feed reminding them about health issues for their children in their first days.

Step 2: Figure Out What Your Patients Want to Learn

Many medical practices use social media to answer common patient questions on topics like flu shot availability or changes to insurance plan acceptance. You can also use Twitter and Facebook to share links to relevant news articles (e.g. “Great article in the Times on recovery from knee surgery”). Or, you can share a blog post you’ve written yourself. One simple way to know your audience’s interests and habits? A quick waiting room paper survey on what patients would like to hear from you, and where they get their health news from now.

Step 3: Choose Content That Appeals to Your Patients

When it comes to pointing your patients to outside information, think about your audience. For example, if you’re a pediatrician, preteen patients will probably appreciate links to YouTube videos where Justin Bieber talks about the importance of an active lifestyle. If you’re a physician serving largely college-aged patients, sharing the Bieber video would paint you as out-of-touch, though. To get your point across here, a better bet might be to link to an article in Marie Claire where Scarlett Johansson advocates regular STD testing.

Step 4: Create a Schedule and Publish Regularly

Start out that schedule with a date to set up a Facebook business page linking to your practice’s website. Then share one news story and one educational resource each week. To make your task easier, identify five news sources and three educational resources you trust. Once Facebook is under control, create a great LinkedIn profile. Surf around and find peers whose profiles you envy, then use their style and format for inspiration. Next, reach out to current and former colleagues to “connect” and get recommendations. Recommendations enhance your credibility, and will help you appear near the top in LinkedIn search results. To round out your social media presence, add a Twitter account. Find colleagues and news sources to “follow,” and start small, with the intention of creating a two-sided conversation.

Step 5: Monitor Your Online Rep and Manage It With Care

Unsubstantiated reviews on sites like Yelp can be confusing and misleading–so presenting your own online bio is critical. Another benefit of an online presence? Prospective patients looking at your practice’s Facebook page will be notified if any of their friends are already fans of your practice. After all, the whole reason advertisers drool over Facebook ads is that it’s proven that recommendations from peers carry significant weight when people are making decisions. Let your patients know when you go on Facebook and ask them to become fans of your practice. Avoid adding them as personal friends from your personal account, though, since that can violate patient-doctor ethical boundaries.

To take control of your social media presence, you needn’t be witty or a social butterfly. You just need to plan and research well, which most doctors can do naturally. The first three steps I lay out don’t involve the social networks yet–they involve understanding your target audience: current and future patients. Once you’ve verified your patients use social media, figure out what they’re interested in learning from you, and what kind of content you’ll use to provide appropriate information. Then, setting up your Facebook, LinkedIn, and Twitter profiles is straightforward.

Thanks for reading, and please feel free to share any comments on what you think I’ve missed. You can write in the space below or email me at katie@softwareadvice.com.