MedicaLogic enables patients to create CPR for themselves
MedicaLogic enables patients to create CPR for themselves
By ARTHUR GASCH
Healthcare InfoTech Contributing Editor
There is an interesting awareness among medical suppliers of the rise of consumerism in healthcare. It is taking many forms, including dissatisfaction with managed care, exercise of political power, and greater involvement in healthcare decisions. The Internet has become an enabling technology for the consumer, including the healthcare consumer. Savvy companies are realizing this, and instead of working against it, are working for it. One such company is MedicaLogic (Portland, OR).
MedicaLogic has become one of the more widely installed physician office CPR products with its popular Logician product. The company says more than 7,000 physicians are using the product to create notes and electronic medical records every day. Logician has about 10 years of experience with installed sites. Recently the company has realized that many doctors, particularly those in smaller practices, are simply not up to running either a Windows NT or Unix-based server and administering an office network which is required for several terminals running Logician. They also realized that a typical medical group practice had early adopters, but also more "pragmatic" physicians, and even some skeptics who were reluctant to commit a major investment to an office-wide CPR that might not work for them. What was needed was a system that could be easily implemented on a physician-by-physician basis, without disrupting the office process of the more skeptical MDs. Then, the skeptics could be won over by the efficiencies and other advantages gained by the early adopters, ultimately joining them in the CPR revolution.
To accomplish just this feat and make its powerful Logician Enterprise CPR system more broadly available, MedicaLogic has web enabled it, in a new application called Internet Logician. If that was all the company had done, it wouldn’t really be news, but it went farther and web empowered the patient at the same time. All of this is wrapped up in a new product called Logician Internet, as opposed to its current product, known as Logician Enterprise. MedicaLogic announced this new offering earlier this month at the eHealthcare World conference.
Logician Internet enables doctors to capture patient encounters in their offices, using any PC or laptop, and then to transmit the captured encounters in real-time (with a continuous Internet connection) or later (at the end of the day) in a batch mode via a dial-up 28.8 Kbaud or faster connection, to a MedicaLogic managed clinical notes repository. All that is required is that the PC have Internet access and a web browser (either Netscape or Internet Explorer will work just fine). To this MedicaLogic adds the necessary encryption and security wrappers, so that patient data coming into its repository from across the net is secure. It also manages records backup and other administrative tasks that normally would be provided by a system manager in the office. What this achieves is to allow physicians to start using the product without the normal delays, expenses and re-engineering required to install the Enterprise version on site.
The Internet version of Logician updates its own application software whenever it becomes available, and each user connects to the server. The update is transparent to the physician user. In essence the application serves as a 3-tier client/server arrangement, with the MD having the PC client, and the Internet connecting him to the Application server, and that server connected to the clinical repository, back end server. This approach puts MedicaLogic clearly in the "outsourced data processing and medical records business," an interesting expansion of its core business model.
Internet Logician also is more limited than the full Enterprise version, handling just the patient encounter and some custom reports, but omitting billing and other tasks usually already in place. In this way, it fits in to whatever scheduling, billing system the office may already be using.
The Internet version can receive HL7 messages from hospitals about patient discharges however, and can also interact with patients, which is the second, unique part of the MedicaLogic strategy. The physician has access to the MDPlace.com site, which allows chat sessions with other physicians, and professional discussions between providers.
A companion to the MD Internet product is the AboutMyHealth.net site that helps patients access their charts and physicians. Patients can access all their physicians and all the individual charts, although each physician can only access his or her own chart about the patient. In this way, the patient can use the MedicaLogic site as a virtual patient records repository for themselves, granting access to new care providers as required. The patient can also access the log and audit trail of everyone who has had access to their chart and when, giving them a good overview of who is in and out of their medical records. As all providers know this, inappropriate accesses to patient charts will be minimized.
Not all of the patient’s information is accessible by the patient, mostly their problem list, medication list, advanced directives, and allergies, among others. Patient demographics are accessible and updatable by the patient items such as street address, telephone number, etc. Individual encounter notes the MD made are not accessible to the patient, although they are stored and accessible by the physician seeing the patient. Using this site a patient can request an appointment from a physician, and the MD can then e-mail a confirmation or suggestion for an alternate time back to the patient.
All of these sites and the interactions with them meet proposed HIPAA standards for encryption and security, using encryption, secure socket layers, and other mechanisms. In the future digital certificates and biomedic ID may be added if current HIPPA regulations are substantially changed by further legislative or executive order after August 1999. Also the cost and pricing structure has been changed. Gone is the $25,000-per-seat expense of Logician Enterprise. In its place is a flat charge per patient chart per month. This charge is further offset by the elimination of transcription costs that typically run $2 to $3 per chart times 5,000 notes per year for the typical 1,000 to 1,500 patients a doctor has in a practice. What Logician Internet does is make adoption of the electronic CPR much easier, extracting most of the hardware and system administration tasks, and keeping the costs low.
The Internet Logician Internet program is working live at six pilot sites now, and will be rolled out to the general physician base in 90 days, after initial kinks (if any) are resolved. Because the system is Java-based, it will run on just about any type of computer or operating system the practice may already have, not just Intel systems running Microsoft Windows. The product supplements paper charts, but does not totally eliminate them. Indeed, as part of the transfer of data up to the repository the MD can print encounter sheet summaries for their paper files they may wish to maintain in their office.
This clever approach may prove the comments and actions of some of the bigger players to be premature. McKessonHBOC has let go 20 people in Israel who had been working on its Smart Record product, and IBM’s healthcare chief has pronounced the office-base EMR to be an impossible task. Glaxo Wellcome dumped its Healthmatics EMR group, only to have it acquired by A4 Healthcare Systems. While some companies are busy abandoning the quest for the CPR, other companies like MedicaLogic are busy figuring out how to get it off the runway and into the air.
But Logician Internet is not just for doctors who have no current CPR product; it also is useful to current Logician Enterprise customers who wish to empower their patients. MedicaLogic will be adding this on to existing sites as well as offering it to new sites and physicians who have never before had a CPR product.
The missing ingredient for a successful flight is inviting the patient/healthcare consumer to come along, and empowering them to participate as an active stakeholder in the CPR implementation process. MedicaLogic, with Logician Internet, MDPlace.com, and AboutMyHealth.com, looks to succeed by putting the patient back at the center of the healthcare process.
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