Just last winter, the hospitalists at University Hospital in Ann Arbor, Mich., wrote down patient orders the old-fashioned way, scribbling them onto three-ply carbon paper and distributing them to nurses, pharmacists, and X-ray and lab technicians.

Now, the hospital has come of age by adopting a computer physician order entry (CPOE) system. Instead of carbon copies, the hospitalists use desktop or laptop computers to order drugs and tests on line.

On paper, this may be a practical approach to dealing with patient care and the ever growing need for streamlined communications. In the real world, case managers and nurses still rely on informal conversations with physicians to provide the subtle feedback and detail needed for proper patient care... Read the full article.

In an interesting article written by Jim Knaub for Radiology Today, we find out the hottest topics for 2009 in the radiology and imaging industry.

The Economy, Reimbursement, The Economy... I see a pattern. Read the full article.

Cardiac CT is no longer new. In fact, as more 64-slice CT machines have penetrated the market, cardiac CT is new and improved. The technological advances came quickly - so quickly that though the technology is mainstream, instruction in its use has yet to become standard in medical school curriculum's or resident training. This will soon change...

Imaging Economics has an article in the December 2008 issue discussing how in the near future (2010), proper credentials to perform cardiac CT exams and reads will be needed . Will this improve reimbursement? Read the full article.

While the conventional wisdom holds that health care is recession-proof, many hospital CEOs are worried that the financial crisis that is circling the globe may be the exception to the rule. Leaders of the hospitalist movement, however, say there may actually be a silver lining to the dark financial clouds that are causing so much anxiety. Read the full article.

Its feels like just yesterday, companies put the letter “i” in front of everything in order to sell products. Now in 2009, with the emergence of serious technological advancements to patient care comes the “iPatient”. “iPatient” is the new term being used for the virtual representation of a patient based on all the lab tests and imaging.

In his article, Stanford Physician Abraham Verghese, MD describes a dialectic tension between the two approaches to patient care. In the first, the traditional or old-school method, the patient’s body tells the story. The doctor works as “bedside-sleuth” using inspection and palpitation along with the help of technology to determine a treatment course. Well-trained in the use of tuning forks, stethoscopes and knee hammers, he or she can detect disease in the appearance, in the gait, in a pulse, well before the relevant test might even be ordered.

The growing trend toward the second method — one that focuses on the “iPatient” — parallels the recent explosion in medical technology. Read the full article.

14 Tips to Prevent No-Shows

Here is a great article written by Kathleen Quinn, MBA, RN, MGMA member and director, University of California–San Francisco Department of Orthopaedics. The article can also be found on the MGMA website.

Patients who fail to keep appointments without notice – no-shows – adversely affect patient access and clinical revenue. When a patient fails to keep an appointment and does not give notice, it’s not possible to offer the slot to another patient, even that day.

The problem of no-shows has no single solution. The reasons for no-shows vary greatly among practices. However, the approaches we describe for our academic medical center can be applied in any practice setting.

Establish a cancellation line – Put a cancellation option on the automatic call distributor that routes to voice-mail around the clock, and check it regularly.

Send reminder letters – These are mailed to patients with three or more missed appointments in a 12-month period.

Put up "good citizen" signage – Posted in elevators and other locations, these signs say "We know that things come up and sometimes you can’t keep a scheduled appointment. When that happens, please let us know as soon as possible so we can offer your appointment to another patient. Call our cancel line 24/7 at ###-####."

Use a training bulletin – It reminds employees that they can view a patient’s no-show history in the scheduling system for the last 12 months.

Automatically generate letters from the scheduling system – Send notices to patients who have missed three appointments reminding them to call at least 24 hours in advance when they can’t keep an appointment.

Revise/shorten the automated reminder message to a "quick listen" – Because some patients hang up on a lengthy reminder message, we shortened it considerably.

Overbook the schedule to cover for no-shows – Provider buy-in is critical. Start conservatively and overbook by half of the no-show rate or some other portion.

Create "standby" appointments for patients with a history of no-shows – This offers an opportunity to increase revenues by seeing more patients and may reduce the no-show rate.

Use open-access scheduling – This requires resources to reduce the backlog of demand, such as locum tenens to increase sessions in the short term and analytical support to predict and monitor demand.

Remind staff to look for existing appointments before offering another – This is necessary in case the patient is calling to reschedule an appointment or has forgotten an appointment made at checkout.

Discharge from practice based on defined number of no-shows – Our No-show Task Force recommends that five no-shows in a 12-month period trigger a review to see if discharging the patient from the practice is clinically appropriate.

Define no-show criteria – A training bulletin on this topic ensures consistency across practices.

Have provider discuss no-show behavior with patients – Having a nurse or physicians discussion the issue with patients that have a no-show history may convey the importance of keeping appointments.

Create a no-show report – You can use this for preventive measures, such as reminder calls and cards, and overbooking those appointment slots.

In the current health care market, patients are seeking enhanced access to care and top-quality customer service. One example of this demand is the substantial expansion of retail clinics. Offering patients walk-in service, these clinics have achieved some success through catering to patients’ desire to have easy, immediate access to care. Offering patients what they want will help keep your practice competitive. The following are questions that can help you assess and improve your practice’s patient offerings.

1. Do you offer convenient hours—before and after regular business hours?

To accommodate patients that work during the standard business hours of 9 a.m. to 5 p.m., you may wish to offer early morning, evening and/or weekend appointments. Patients who cannot easily take time off from work will appreciate the access and convenience of these alternate appointment hours.

2. Do you offer same-day appointments (open-access scheduling)?

Open-access scheduling, often referred to as advanced access, is a patient-friendly system that allows patients to schedule appointments without waiting for several days or weeks to see their physician. Open-access scheduling is an effective way to decrease your backlog of appointments. You see your patients for an appointment the same day they call, regardless of whether the nature of the visit is urgent or routine. For example, you might book 35 percent of your schedule and leave 65 percent of the schedule open for appointments that will be scheduled the same day. When patients are able to see their physician the same day and therefore resolve their health issue sooner rather than later, there is both a greater sense of control for the physician and improved satisfaction for the physician and patient alike.

3. What is your procedure for urgent patient concerns after hours—is there a physician on call who is readily available?

If you do not have a physician on call to speak with patients during hours that your practice is closed, you may wish to partner with other physicians in the community to offer patients extended coverage. Patients will appreciate knowing there is a physician available to help them no matter the time of day or night.

4. When patients call your practice, can they speak directly with a nurse or physician? Will the nurse or physician return their call promptly? How soon do you return calls and address patient issues?

Listen to your patients. Are they asking to speak to a nurse right away or within a certain time frame? Does your practice have the resources to offer this service? Are patients upset if they are unable to speak with the nurse or physician? If this is a problem area for your practice, you may wish to consider how you can better meet this patient expectation (e.g., set aside a certain time during the day for the nurse and/or physician to return calls in a prompt manner).

5. Do you offer to call or send prescriptions directly to the pharmacy so that patients can pick them up without having to wait?

You can save your patients time by calling, faxing or sending prescriptions electronically to the pharmacy. A patient who does not feel well truly appreciates being able to pick up his or her prescription from the pharmacy without first dropping off the paper prescription and then waiting for at least 20 minutes while the pharmacy fills the prescription.

6. Do you accept credit cards, debit cards and automated clearinghouse (ACH) debits to facilitate patients’ payments due?

When you offer patients a selection of payment methods, patients may be more likely to pay their balance and will appreciate the convenience.

7. Does your practice have a Web site? Does your Web site offer online appointment scheduling and convenient access to patient registration and other patient forms?

Web-based appointment scheduling allows patients to book their own appointments via the Internet 24 hours a day seven days a week. This will facilitate the appointment scheduling process by freeing up practice staff time spent on answering calls to schedule appointments and will save your patients time as well.

Your Web site can also offer convenience to patients by offering new patient registration forms to complete and submit online prior to their appointments. This capability will eliminate the need for patients to arrive 15 minutes before their first appointment to complete such paperwork. Your practice will also be relieved of the administrative burden of obtaining and entering this data at the time of the visit.

You can also keep your patients well informed of various practice policies, such as patient financial responsibility; appointment cancellation; privacy, services and procedures performed, by posting these policies on your Web site.

8. Do you survey your patients to assess how well your practice is meeting their needs?

You can use patient surveys to obtain your patients’ genuine opinions about your practice, including the appearance, comfort, patient flow, wait time and patient interaction with the physician and practice staff. Patient surveys uncover patients’ appraisals of their unmet needs. You can identify any bottlenecks in patient flow by asking your patients about their wait times, which begin when they enter the office and end when they leave (including the time they are in the waiting area and the exam room). Patients will appreciate having the opportunity to confidentially express both their concerns and satisfaction and offer their ideas for improvement. Be sure to address the survey results by implementing improvements to your practice.

Nothing's more important to your productivity arsenal than a solid scheduling tool, and considering so much of what we do happens at the computer, a good calendar application is just the thing to bring order to your agenda. At PPR, we include an integrated patient scheduling tool with our practice management system. If for some reason you want to keep your calendar separate, here are a few good applications that may help you keep your day in order.

Google Calendar (Web-based)

Ever since it launched in April of 2006, Google Calendar has quickly built a reputation as the premier web-based calendar. GCal owes much of its popularity to its anywhere accessibility and for bringing the look and feel of a desktop calendar into the web browser. It's fast, it's reliable,and it's continually improving. Even better: GCal can sync with virtually any desktop calendar.

Thunderbird with Lightning (All Platforms)

Combine Mozilla's email application Thunderbird with the Lightning calendar extension and the popular open-source email client instantly becomes a robust calendaring tool. Lightning is relatively young, so it doesn't yet support full integration with your email and contacts like Outlook (luckily those features are on the Lightning roadmap). However, for a free, cross-platform calendar app, you can't find much better than Thunderbird with Lightning. If you'd prefer a stand alone calendar to email-plus-calendar, be sure to check out Sunbird,which is basically Lightning as an independent app.

Microsoft Outlook (Windows)

Microsoft Outlook is the de facto calendar and email application of most of the corporate world. However, with Exchange server support, email integration, Windows Mobile syncing, and great collaboration tools, Microsoft Outlook really earns its place as a killer desktop calendar. The biggest drawback: Outlook comes with a hefty price tag.

iCal(Mac OS X)

iCal comes standard with Mac OS X, and this simple but increasingly powerful calendar application proves to be all many Mac users ever need. iCal integrates smoothly with the rest of the your Mac apps, supports MobileMe syncing, and the iPhone/iPod touch version of iCal puts your entire schedule conveniently in your pocket.

Last week's unveiling of a new browser is the latest in a series of moves by Google Inc. to rid the world of Microsoft Windows, according to analysts.

In fact, said Matt Rosoff, an analyst at Directions on Microsoft in Kirkland, Wash., the new Chrome browser could be the key component of Google's plan to convince consumers and business users to replace Windows-based software with hosted Web applications.

"This is the potential threat that Microsoft has been worried about since the 1990s," Rosoff said. "This is Google trying to really push applications to the Web and make that the way people do computing."

Google began offering a beta version of the new open-source browser on its Web site last week.

Chrome includes a new high-performance Java-Script engine and Google Gears, which will let users store and access Web applications off-line. The browser is powered by the WebKit open-source rendering engine, also used in Apple Inc.'s Safari browser, and includes unspecified Firefox components.

At a press briefing, Sergey Brin, co-founder and technology president at Google, said he expects Chrome to serve as a strong vehicle for running Web applications. "I wouldn't call Chrome the OS of Web apps," Brin said. "It's a very basic, fast engine to run Web apps."

Google likely won't position Chrome simply as a competitor to established browsers from vendors like Microsoft, Mozilla, Apple and Opera Software, noted Ray Valdes, an analyst at Gartner Inc.

"It's about the Web apps battle," Valdes said. "It's about having a platform that will support the next generation of Web apps."

Google spent two years making sure its system could overcome the growing inability of current technologies to run new online applications. It was "definitely a strategic initiative," Valdes said. 

Earlier steps in Google's long-term plan to kill Windows include the 2006 launch of the Google Apps hosted applications suite. That offering includes the Google Docs collaboration tool, Gmail e-mail software, Google Calendar, the Talk instant messaging and voice-over-IP application, and the Sites wiki service.

Google is also expected to soon unveil an online storage offering.

Corporate IT managers have so far been unenthusiastic about replacing packaged software with Google's Web-based offerings. Robert Ford, CIO at Virgin Entertainment Group Inc., said Chrome likely won't change that view, at least at Virgin.

Although Chrome is impressive, "there would have to be astronomical performance improvements for us to switch," Ford said.

He noted that IE is the Los Angeles-based retailer's corporate standard, and developers there are expert in Microsoft .Net-based technologies. "I don't see any reason to challenge our IE standard," Ford said. "I'd have to make sure Chrome worked well with all of our other apps. What is the business value in that?"

In a statement, Dean Hachamovitch, IE general manager at Microsoft, said the company expects most users to continue turning to Internet Explorer, which holds about 72% of the browser market, according to Net Applications Inc., an Aliso Viejo, Calif.-based Web metrics research firm.

Sheri McLeish, an analyst at Forrester Research Inc., said that Chrome "is not compelling enough to erode Microsoft's dominance. Too many IT shops are comfortable with IE."

McLeish noted that persuading users to switch browsers is a difficult task for any vendor. Even Microsoft has faced challenges getting users to upgrade to new versions of IE, she said.

Rosoff added that Google also faces a significant challenge in finding ways to distribute the new browser.

"Google is a powerful brand, but they do need a way to distribute the browser," he noted. PC makers, an obvious potential distribution path, may be wary of replacing Windows with Web-based applications - Computerworld.com