Archive for November, 2009

Product Review: NextGen

November 25th, 2009

Just recently I evaluated 3 EHR systems (AllScript, NextGen and eClinical) and will gradually dump my notes into individual reports for each one.

NextGen (by Quality Systems (NASDAQ:  QSII)) provides an all-in-one solution, including PM, EMR and Billing.
Among the three, NextGen has the best user interface. It is intuitive and easy to use. 
The visual aid helps physicians to point and click their way through an entire exam.
NextGen EMR is completely integrated system and supports different specialties. It has a large selection of pre-built templates to help automate the workflow.  
Having said that, the product philosophy is that you will like the pre-built templates as they are. Adjustments are possible but that is relatively hard and would require engineering support. 
For example on HPI screen symptoms are listed as check-boxes in comparison to decision-tree-style selection lists that are used by many other vendors.
This is presented by NextGen sales as a competitive differentiator that removes the restrictions of sequential questioning needed in decision-tree pick lists.
NextGen EMR integrates with NextMD, which is the company’s patient-provider portal that facilitates effective electronic interactions between the patient and the practice.
The NextGen product is written in Visual Basic and Visual C++ and uses MS SQL database and Active Domain.  This implies an open architecture for custom developed extensions, such as integration adaptors and complex reports. NextGen has its own integrated word processing for creating/customizing letters and communication materials. The company is currently working on optional interface with Microsoft office.

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Product Review: PracticeFusion

November 8th, 2009
I have been recently exposed to PracticeFusion, a three years old player in EMR market. They offer a fully hosted (SaaS) PM and EMR system at no charge! (more about it below) 
The product is very easy to setup and use.  The user interface is self-explanatory and intuitive. Each top category of functionality has a short video tutorial that helps getting started.
Adding Patients, scheduling visits and dealing with charts is very simple. 
The only thing I didn’t like must was document handling, which is not as easy to work with, specially if you are dealing with lots of scanned materials. 
They have partnered with Digital Island to offer conversion of paper charts into electronic charts. 
As for billing, they offer own integrated billing system that charges about 6% of receipts that are received and deposited. Alternatively they offer secure email system for working with existing internal and external billers. I am not sure how well this will work!
The Web interface takes advantage of Flex 3, Adobe’s rich Internet application interface and the system backend is cloud-based and ensure scalability.
However as many other SaaS solutions there are few points to keep in mind:
Switching to another solution provider is going to be a nightmare. There is no easy way to get the data (which you own!) and move it to other hosted solution. 
So basically you are stuck with one SaaS provider as soon as you start.
Furthermore there is a question on what happens when Internet goes down; how would you access schedules and patients’ records during that time?
And finally, there is always challenge of integration in SaaS environment, in this case,
for example, integration with medical devices and instruments.
In terms of functionality E-Prescription is the most important missing piece, which seems to be a priority items on their roadmap. 
As for business model PracticeFusion plans to make money on free software by connecting advertisers with doctors while they are working on the system. Apparently they have already signed up advertisers such as Johnson & Johnson, AstraZeneca LP and Ortho-McNeil-Janssen Pharmaceuticals, Inc.
Given how difficult it is for a drug salesperson to get a doctor’s attention, the CEO, Ryan Howard, is convinced this business model will work.
For Physicians who don’t like to see ADs on their screen, an AD-free version of the solution is available at $100/month/provider.
For more info here is an interview with Ryan: 
In August 2009 Practice Fusion received an investment from 
The investment is reportedly between $5 to $10 million. 
As a side note, to me this was an excellent strategic move by SalesForce, which is heavily focused in promoting its cloud platform.



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EHR to Bridge the Two Parallel Worlds

November 6th, 2009

These days I am spending some time on Process Improvements at Life Sciences and Pharma Companies. While doing so I noticed how much the Healthcare reform is going to help Life Sciences industry, indirectly.

Historically Life Sciences and Healthcare industry have been two strange and detached worlds.
But EHR related activities and standardizations, such as HL7, are creating more and more touch points for bringing these two parallel worlds together. 
The interoperability between EMR and CTM systems, and resulting interactions between Site Investigator and Primary Physician during Clinical Study are some of the obvious benefits.
On the technical side, I see CDA and CDISC to gradually converge on data structure, while utilizing XSLT for transformation at the end points to integrate clinical research data and health care data.


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The EMR war is still going on ..

November 2nd, 2009

 The EMR war is going on and will intensify in the coming years. Vendors are becoming more and more aggressive and innovative to gain and keep their market share in the rapidly growing EHR market. This competition will ultimately benefit EMR users with better products in the long run. But in the short term it will eventually make the buying decisions harder.

Among recent products updates is one from Praxis.
Praxis just announced a new EMR system that learns from the physician using it.
According to the company EMR templates reduce Physicians freedom of expression, as they are nothing more than a boilerplate developed by a third party or expert for inputting clinical data. The inflexibility of templates causes a series of problems during everyday use.
Praxis upcoming version 5 is using Neural Networks to overcome this inflexibility by letting the software adopt to Physician instead of expecting the other way around. 
Being fanatic about Artificial Neural Networks (ANN) I would like to see them succeed! 
If you are interested in learning more about Artificial Neural Networks read on my other site.

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