The Technology Review Site for Primary Care Providers
Advances in technology have improved healthcare providers' ability to rapidly diagnose patients at the point of care, screen for common conditions, and provide a variety of effective treatment options. Providers need to be aware of what innovations are available - or will become available in the near future. It is the purpose of Medgizmos to educate and inform healthcare providers regarding the latest and greatest technologies.
ScopeAround Wifi Otoscope, new inexpensive digital otoscope!
The old-fashioned way to communicate with patients is via letter or phone call. Too often patients who wish to schedule an appointment or ask a physician a question, have long waits on hold. Patients get frustrated and often consider seeking care outside of their medical home. Additionally, physicians who return calls to patients, encounter full mailboxes and waste precious time leaving messages for patients. What follows too often is an endless game of “phone-tag.”
The best method of communicating with patients, given today’s technology, is via a HIPAA compliant messaging system such as Gnymble, detailed in this video interview and demonstration of the system. Gynmble was developed by Bryan Fine, a pediatrician and entrepreneur. The interview with Dr. Fine and Kaylee Niederhelman, Gnymble’s Director of Business Partnership discusses the nuances of Gnymble. One can message a patient or broadcast a message to many patients. One can copy and paste messages into the office notes. You can even customize your responses with the names of the parents, and patients, and include images or files to enhance communications.
The system is very affordable and should be considered by any primary care or specialty practice who wishes to improve communication with patients.
I’ve been using Dragon Medical for years and each iteration improves on the previous version. Nuance recently released Dragon Medical One and it is truly wonderful. No longer do you need to “train” the software. With your first use – the accuracy is terrific. This version is server based and users install an application on their smartphone to enable the phone to function as a wireless, network connected smart microphone.
The application enables users to assign commands to different “buttons” so you can choose to move from one field to another, activate voice macros that insert templates or move to different areas of the EHR.
One can dictate twice or three times the speed at which one types. This means than once you become facile with Dragon Medical One – you complete your notes much faster than you can by typing. This means that you can complete notes before the end of the workday. No longer will you need to take work home with you. The need for completing notes at home is a major cause of provider “burnout”.
It is worth your time to not only to become skilled in dictating notes, but to take the time and effort to develop macro voice commands that insert phrases, templates, or navigate within the EHR or within the operating system. You should read the manual (of course) which will quickly educate you how to delete or replace phrases, correct words or add words to your vocabulary. Outstanding!
When patients or parents call, practices should have a triage system in place to make sure that patients receive the appropriate level of care (office, emergency room, home care), and are seen in a time frame appropriate for their medical condition (urgently, same day, within a few days).
Approximately 30% of calls received by pediatric practices are for nurse triage. It is very important that office nurses use established protocols when triaging calls, and carefully document each encounter. As most practices use EHRs – nurses needed to document within the patient’s electronic chart. As we know many of our EHRs are labor intensive, and often take longer to complete compared to a simple handwritten note.
Following triage by an office nurse, 57% of patients just need home care advice, 21 % are seen the same day, 16 % are seen within 3 days, 3% are sent to the ED or urgent care, and just 0.1% told to call 911. The remainder are given other dispositions (seen in office within few weeks, call specialist, call dentist, etc.) While this office triage is sometimes time consuming, it is the best method to identify the level of care needed for the child of a concerned parent. This is not only good care, but it also reduces liability of the practice.
Over 6 years ago David Schmitt developed ClearTriage, a web based portal that facilitates the process of triaging patients by medical practices. The system integrates Dr. Bart Schmitt’s telephone triage protocols to expedite the process of triaging office calls as well as documenting recommendations.
ClearTriage is very inexpensive at just $49 per month per concurrent user and was one of my “Best Tech” selections in 2015!
David Schmitt discusses the history behind ClearTriage in part 1 of the video interview and demonstrates its use. Part 2 of the interview presents information about Covid-19 protocols and David’s new product called SymptomScreen. This is a web portal that helps nonclinical office personnel to screen incoming calls to determine if an appointment should be made or the call should be handled by a triage nurse. Great idea, easy to implement and very affordable, and likely to be selected as one of my “Best Tech” selections for 2021!
Effective January 1 this year, the Centers for Medicare & Medicaid Services (CMS), implemented a new evaluation and management (E/M) coding system for outpatient visits. It was the first change in 25 years, developed to ease the documentation burden on medical providers. Prior to 2021, billing for an outpatient visit required a very complicated mixture of documenting appropriate elements of the patient’s history and physical along with the medical decision-making (MDM) associated with the visit or the time spent counseling the patient or coordinating care. The updated CMS guidelines are based only on 1) a clearer method of assigning MDM or 2) a new methodology for assigning a time component to the visit on the date of service. As they did previously, CMS recognizes 4 levels of MDM (straightforward, low complexity, moderate complexity, and high complexity). MDM quantifies the complexity of establishing a diagnosis and/or selecting management options by measuring: 1) The number and complexity of problems addressed at the encounter, 2) The amount and/or complexity of data to be reviewed and analyzed, and 3) The risk of complications and/or morbidity with patient treatment. Alternatively once can also bill by the time spent Indicating the time associated with an encounter is an alternative method of determining the level of the visit. For many physicians, using time to determine a level of service is much less confusing compared to assigning a level of service using MDM. In contrast to the pre-2021 method of assigning time associated with the face-to-face time spent counseling the patient or coordinating care, time now consists the time preparing to see the patient, obtaining a history, performing an examination, ordering medication or tests, coordinating care, communicating results to the patient .
I’ve always depended on EMUniverstity.com learn about the nuances of medical coding. Peter Jensen is a physician and certified coder and does an excellent job of explaining the new system in a clear and concise way. The online course is about $300 and you earn CME credits for participation. Highly recommended!
I’ve become a fan of the GoodRx web site and GoodRx mobile applications over the past year. The reason – this advertising supported service has saved my patients (and myself) considerable $$$ when they seek the lowest price for acute or chronic medications. Medical providers realize that the copay for many of the medications we prescribe are often ridiculously high, and everyone appreciates finding the lowest price for their meds. As discussed in the video, prices for medications vary tremendously from one local pharmacy to another. GoodRx finds patients the lowest prices!!! In my area Adderall XR 20 mg, 30 pills can be had at Walgreens for $75.62, while at Walmart the same prescription goes for $189.19. Patients also can learn about lower cost alternative medications, saving money by getting 90 day prescriptions when applicable, or cutting higher dosage pills in half.
There are GoodRx mobile applications for patients as well as for providers. Patients can put together their medication list, find the most affordable pharmacy for all their scripts, and receive alerts when prices change or new discount coupons become available. The provider application lets one compose a favorite list of frequently prescribed meds. The provider can message patients with pricing information via an email message sent via GoodRx. Patients have been very pleased with the service and I continue to make patients aware of its availability. Check out the video to review all features!
One of my top 10 applications for pediatric practice is Pediatric SymptomMD – because it presents excellent advice for answering those questions asked by new and experienced parents. I keep it in on my iphone so I can demonstrate its use at preventive care visits, and I encourage all my patients’ parents to use the application before they call the office or answering service. The app was developed by Dr. Barton Schmitt who developed wrote the first book on Telephone triage in 1980. Dr. Schmitt is currently the Medical Director, Pediatric Call Center, Children’s Hospital Colorado, as well as Professor of Pediatrics at the University of Colorado School of Medicine
Dr. Schmitt’s telephone triage protocols are used by call centers and medical practices across the country and throughout the world. Pediatric SymptomMD is an outstanding application because all information presented is derived from Dr. Schmitts protocols. This means that the advice given has been thoroughly vetted and essentially is the “standard of care.”
Pediatric SymptomMD includes several modules, including a Symptom Checker, Medication Tracker, a First Aid Section and a Parent Advice Center. The app is available for Android and IOS, sells for $2.99, and has been downloaded thousands of times. You can contact Selfcare Decisions at www.selfcare.info to inquire regarding re-branding the application for your practice or hospital!
I am pleased that Dr. Schmitt agreed to present and discuss his application with Medgizmos.com. Here is Dr. Schmitt discussing the symptom checker module of Pediatric Symptom MD.