How to navigate the changing maze of medical management software
April 1, 1999 6 minutes read
How to navigate the changing maze of medical management software
There’s a program for every need and almost every interest
Medical software programs are a lot like spring daffodils: They seem to be popping up everywhere. Some of them have life spans about as long.
In a technological world that is changing at a blinding pace, health care professionals battling managed care expectations are struggling to sort out the vast array of options on the road to the paperless office.
Even savvy young doctors like Eric Buehler, MD, a family practitioner in Waynesville, NC, a mountain community of 10,000, are reluctant to bring their offices into the information age. The reasons most often cited: expense (in time and dollars), and the uncertainty about what will work best for them in the rapidly changing marketplace for medical records and disease management software.
Yet, Buehler concedes virtually every medical office will need to be computerized in the next five years or so because, in the end, "it will be far more efficient."
Medical practice and patient management software is the newest niche market, says Ken Later, product manager of Clinitec International Inc., Horsham, PA, which developed the NextGen electronic medical records system.
"We are at only about 4% of the potential market, so it’s still very new and exciting," Later says. "We expect 10% of the physicians, clinics, and hospitals will be looking for products like ours in the next couple of years."
The market for electronic medical record keeping and disease management software has grown from virtually no sales five years ago to a $750-million market in 1998. It’ll only get bigger in the future, experts predict.
Software companies, battling for market niche, are offering an ingenious variety of means to run practices, access patient records, define risk factors and even forecast those who are likely to require costly procedures if they continue on their current health track.
Some provide access to formularies and disease management protocols of a wide variety of managed care companies, so they treat patients according to the managed care plans and prescribe medications approved under the plans.
Case management software is popular
"In the past six months, we’ve had increasing requests from health care plans for case management software," says Bob Darin, PAHM, manager of the business development division of Blue Cross-Blue Shield Association in Chicago.
Blue Cross is engaged in a study to determine what doctors, case managers, clinics and hospitals want and need to manage cases electronically.
"They want to facilitate the flow of case management, to break down the barriers," says Darin. "They want to pull up data as needed, and easily and quickly determine what patient needs are and what are the right interventions."
Buehler agrees with the concept, but still balks at the reality as it stands today. Even though he’s only two years out of his residency and a self-professed computer nerd at home, Buehler has no plans in the near future to computerize his office other than the new computers he recently purchased for his lab and appointment scheduling.
The reasons? "First, it’s a matter of getting all the data from all the charts into the system. That’s enormously expensive in terms of time and money," Buehler says.
The second show-stopper, Buehler says, is the cost of the software itself and need for a computer in every examining room. And finally, he says, there is the major consideration of "what will work for me" amid the avalanche of available programs.
Custom designed software fill MDs’ needs
Bob Keet, MD, FACP, medical director of Axolotl in San Jose, CA, and an internal medicine specialist in Santa Cruz, CA, acknowledges the health care industry has been slow in embracing new technologies because of the high cost and fear the system might become obsolete in a short time.
That’s why Keet and a group of physicians, hospitals, laboratories, and pharmacies in Santa Cruz formed their own network to meet precisely defined needs, designed their own software, and have now began to market it through a company they formed called Axolotl.
Keet says they went electronic a year ago with a messaging system linking the various components of the community’s medical system and providing quick-return lab reports, referrals, and case histories transferred across the Internet through an elaborate e-mail system that provides a simple tool for the information to be sorted as health care professionals need it.
One of the more attractive features of the system, Keet says, is that communication is unhampered between health care providers rather than each facility having a data base that works only inside the individual organization.
He also reassures those concerned about privacy in transmitting data across the Internet. "There’s no great basement somewhere, physical or virtual, in which a huge database is stored and which hackers might try to break into. What happens is that there are short bursts of information transmitted by e-mail — encrypted, of course — and this is an extra protection against violation of privacy."
However, there have been some unnerving breakdowns in Internet transmissions. Recently, several thousand records containing patient information and Social Security numbers at the University of Michigan Medical Center inadvertently lingered on public Internet sites for two months.
A University of Michigan spokesman says the appointment-making data was erroneously "parked" on a Web server thought to be secure. The database was moved immediately after two people accessed it. "It was a human error. We are now being hypervigilant and we’re building a system of firewalls to be sure it can’t happen again."
The problem came to light when a student searching for information about a doctor on the medical center’s Web site was linked to file containing patient records that included names, addresses, phone numbers, Social Security numbers, employment status, treatments for specific medical conditions and other data.
Where is the starting point?
Defining a starting point is one of the major reasons practices have been slow in moving toward what many regard as an inevitable "paperless office" managed exclusively through computerized records.
Some programs merely choose a starting point and begin entering records from that point. Others "grab" records from a variety of databases and merge them into a megabase. Still others engage in a tedious and expensive process of key punching individual records.
"It all depends on what an individual plan or practice wants," says Blue Cross’ Later.
Healtheon Practice, another recent offering on the market, is an Internet-based referral and authorization program for physicians and patients. The software, developed by Healtheon Co. of Santa Clara, CA, assures secure access to patient and provider information.
"The main difference in what we do is we use the Internet for real transactions," says Charles Saunders, MD, the company’s medical director. Those "real transactions," Saunders says, include interaction between physicians, payers, labs, and pharmacies.
"We can virtually guarantee privacy because there is an elaborate system of password IDs."
ThinkMed Expert, a case and disease management software produced by ThinkMed Inc. of Milwaukee, looks to an unusual place for its information: claims data that is used for billing and already in the system, thereby eliminating a great deal of the data entry.
"Information that was once unusable for clinicians, case managers, disease managers, medical directors, and people who have a responsibility for patient populations is now usable and can be a good predictor for those at high risk," says Warwick Charlton, MDF, ThinkMed’s vice president of clinical design.
He adds, "ThinkMed realized there were patterns in the data where you could start making good guesses about the future health of individual patients."
Charlton says ThinkMed flags those at high risk of complications of chronic diseases and alerts health care professionals so measures can be taken to prevent those complications.
Most of the new software require nothing more than a PC or a network of PCs in which software can be installed and staff trained. Some of the higher-end programs require a mainframe to which terminals can be connected.
The cost for most is high — from a minimum of $30,000 for a small practice to millions of dollars for a large health system — but experts argue the cost is justified by the savings in personnel and time.
Cost effectiveness is individual issue
Keet says he estimates a medium-sized practice of 12 doctors would save the equivalent of two full-time employees’ salaries and save each doctor about 30 minutes a day.
Later’s NextGen promises to return 130% to 180% of its monthly cost for medium-sized physician practices all the way up to the 50 Catholic hospitals, nursing homes, clinics, and medical practices in the 12 states that are part of the Daughters of Charity National Health System.
"It’s very much an individual issue, so it’s very important that all participants get together and decide what they need. That’s the key," says Keet.
For more information, contact: Ken Later of Clinitec International at (215) 657-7010; Bob Darin of Blue Cross-Blue Shield Association at (312) 297-5523; Bob Keet of Axolotl at (408) 287-1700; Charles Saunders of Healtheon at (888) 486-9498; and Warwick Charlton of ThinkMed at (919) 363-5222.
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