Manage My Practice

Yep, I’m heading to the Microsoft campus this week to take part in HUG, the Health Users Group Conference. I’m doing my homework and trying to get the most out of my visit by catching up on what Microsoft is doing in the healthcare sector.

I found two great videos by Bill Crounse, MD (hope I get to meet him!) talking about the cool stuff going on at Microsoft Research. Bill is Senior Director, Worldwide Health for the Microsoft Corporation and according to his site HealthBlog, he is responsible for providing worldwide thought leadership, vision, and strategy for Microsoft technologies and solutions in the healthcare provider industry.

It takes a few minutes to download these videos (about 15 minutes long to view each) to your favorite player, but it is worth it, IMHO. I will also consider showing these videos, particularly the 1st one, at my next staff meeting as something to stimulate ideas and give everyone a flavor for what our future might be.

Look for links to his videos in his post and at the bottom of his post: Microsoft Research: How we watch the computer, how it watches us

I’m going to take a leap of faith and try to record a video during my two days at the HUG Conference. Check back to see if I’ve been successful!

My August 20th post (read it here) noted that Dragon voice recognition software has been quietly gaining acceptance as a mainstream solution to hefty transcription costs and EMR integration. 10% of the healthcare providers in the United States are currently using Dragon Medical.

Yesterday, HISTalk noted that:

At least one doc is unhappy that Nuance has blocked the use of Dragon Naturally Speaking with EMRs in Version 10. Nuance states “…we found that some large hospitals were using the consumer editions of Dragon and not getting the accuracy, quality and manageability that would be achieved when using Dragon Medical.”

Nuance responded on HISTalk via comment, saying in part:

“Nuance has made a significant investment in building, tuning and distributing Dragon Medical for exclusive use by the health care industry. The integration and engineering required to deliver the ease-of-use of Dragon Medical with all major EMR vendors, including Allscripts™, Epic, Misys®, GE® Healthcare, NextGen®, Siemens, eClinicalWorks, Meditech, McKesson®, Cerner and Eclipsys®, requires a Herculean effort, comprising thousands of man hours in developing and testing. As one would expect, there is a premium associated with the delivery of this capability and the resources devoted to further hone and evolve the product to meet the specific needs of the medical end user.”

Nuance also points to the Microsoft model of charging differently for enterprise/professional software and consumer software offerings.

I don’t dispute a vendor’s right to charge accordingly for a product that has taken a lot of R & D to bring to the market, but like everything else that has a place in the medical world, it will cost much more based on the healthcare application. A set of plastic drawers for home costs $9.99 at your local store and lists for $99.99 in a medical catalog.

Five years ago I worked for a physician who used Dragon to dictate his office notes. He put in the time to teach Dragon his voice and successfully dictated, edited, and printed his own notes. He eliminated all transcription costs, and was a favorite of the staff as no one ever had to scramble to find his notes. Not surprisingly, he was my physician IT Champion.

For every physician who was able to make it with Dragon five years ago, there were probably ten who didn’t tough it out. Today there are 70,000 healthcare providers using Dragon, which is an estimated 10% of the total healthcare provider population. What’s the big motivator? One, saving money, which becomes more important every year as there become fewer places to cut costs. Two, direct input into the EMR, which saves time and closes the loop on electronic management of physician assessment and recommendations.

Read the full story here.

Here are two of the newest healthcare games on the market. First up, Rite Aid:

They’re giving $30 gas debit cards with the transfer of a prescription to their store. If the Rx stays with Rite Aid, consumer’s name stays in play to win the gas lottery — a $2,600 gas card.

And next, Aetna:

Aetna is sponsoring a study to see if a lottery can enhance patients’ adherence to prescribed drugs. The Aetna Foundation funded a University of Pennsylvania team to use prizes of $10 and $100 to reward consumers to take drugs as prescribed. An electronic monitor (the Med-E-Monitor) will track whether 100 participants are taking their warfarin. 50 patients will be enrolled in the lottery with a 1 in 10 chance of winning $10 a day, and 1 in 100 chance of winning $100. A text message will be sent each day to tell the patient whether he/she won the lottery, or if the dose wasn’t taken, whether they would have won the money. 50 people in the control group will be using the electronic monitor but won’t be incentivized with the lottery game.

Both these games are reported by Jane Sarasohn-Kahn at Health Populi. 

If you are working in practice management, you might want to explore the gold standard in certification through the American College of Medical Practice Executives (ACMPE). Disclaimer: I am Board Certified and a Fellow in the ACMPE but I receive no compensation for writing about the College or having a link to them on my blog.

Why certification as opposed to an undergraduate degree? I think this week’s opinion piece in the Wall Street Journal by Charles Murray says it better than I can. Read the article here.

My son called me today and asked me how to ask for a raise. Here is how I told him I’d like an employee to ask me for a raise:

1. Make an appointment with your boss and let her/him know that you’d like to discuss your compensation. Do not e-mail this request to your boss while s/he’s out of town, their first day back or has a big deadline coming up. Choose your moment. Ask for an appointment several days or a week in the future so you have time to prepare.
2. Make a list of the things you’ve accomplished since your hire or last raise. Include things you’ve learned, ideas you’ve shared, projects you’ve participated in and benchmarks or goals you’ve met or exceeded. Add any new ideas you haven’t already shared. Print a copy of the list to give to your boss after your Mom has reviewed it you’ve spell-checked it.
3. Research your job on the Internet and see how your wage compares with others of the same title or job description. Print out the information (if favorable) for your boss.
4. if you feel heated about your compensation, take the time to write out your feelings or discuss them with someone who doesn’t work with you. Let go of any feelings of anger or frustration and make sure you are calm before the appointment with your boss. Keep yourself from holding any imaginary conversations with your boss before the meeting trying to guess what s/he will say.
5. When meeting with your boss, thank her/him for his/her time and ask if you can share some information you’ve brought with you. After you’ve presented your info, let your boss know (if it’s true) that you really like your job and hope to be a part of the company’s future. Ask if s/he would consider increasing your compensation based on the material you’ve presented, and indicate that you understand s/he might need some time to review the information you’ve provided. Ask when you might be able to meet again to discuss her/his decision.

You’ve been professional, respectful, supported your request with information, and given me time to think about it. As a boss, I couldn’t ask for more.

A great column in last week’s BusinessWeek by Carmine Gallo gives the reader 4 steps to making difficult conversations with employees and coworkers more productive. I like his steps, but I have four of my own, and I’ll let you choose which works for you. Read Carmine’s suggestions here.

Here are my four steps:

Step 1. Always start with a question. I rarely feel that I know the complete story so I typically ask for more information about the issue or behavior in question. Nine times out of ten I learn something I didn’t know that helps the conversation. Asking questions and clarifying information usually gets both parties a little more comfortable.

Step 2. Express your concern about the issue or behavior and let the employee know why you’re concerned. More information helps the employee see how their work interacts with someone else’s or contributes to the organization as a whole.

Step 3. Ask for the employee’s input in solving the issue or behavior. There may be several solutions that would work, and choosing the best one together, or letting the employee choose one is a win/win.

Step 4. Restate the action plan for the resolution and close the meeting with an invitation for either of you to meet again if the issue needs revisiting.

It may be hard to talk to employees and coworkers about issues or behaviors, but if you are in a leadership position, you must learn how to have hard conversations of all types. The secret is asking questions and collaborating on solutions.

When we first moved to the west coast, I was stunned to find that people routinely take two weeks of vacation off AT ONE TIME! On the east coast, my experience had been that taking more than a week off was reserved for getting married or going to Europe. Amazingly, and this was a revelation to me, people can take two weeks off at a time and the organization can go on! Now I am very much in favor of people taking longer vacations for a number of reasons:

1. It forces the organization to cross-train employees and to make sure that there are at least three people in the company that know how to do every critical task.
2. It requires the creation and maintenance of current, clearly written protocols associated with each job, in case the other two employees who are cross-trained on the job get sick, have jury duty, have a death in their family, or quit on short notice.
3. It gives the company an opportunity to assess the workload and composition of a job from another person’s viewpoint. We’ve all had the experience where someone goes on an extended leave and you find out that the job is much more, or less, complex that you thought, or someone was telling you.
4. It ensures that nothing untoward is going on with someone who has access to company money. Everyone’s heard of the manager who never takes a vacation, not because s/he’s so dedicated, but because s/he has sticky fingers.
5. It gives the employee an opportunity to truly rest, heal, and remember that there is life outside of work (can you tell I’m thinking about myself here?)

Here’s an excellent article that has some great points about the ethics of taking Vacations. The author, Bruce Weinstein, PhD states:

Leaving work behind for a period of time is not only acceptable; it is our ethical obligation.

My advice to each of you is to fulfill your ethical duty as soon as possible.