Why are there no Mac’s in the clinic?

The Macs (Apple Macintosh) and most of what has come out from the Apple Factory of Kick Ass Design have been an inspiration to Product Designers and Solution Architects. That inspiration alone has helped todays Software products get Richer in User Experience

In the Health Care industry though, EMR’s, Practice Management Software’s and other Clinical Productivity Tools are primarily built for the ubiquitously available Windows platforms. A huge number are also available for linux, most of these Open Source, and a very small number for the Macs.

In the United States, where the EMR business is filled in with over 300 major vendors, there are apparently only 8 offering EMR’s which are natively built for the Mac.  Read this report by Houston from Software Advice to see these 8 vendors and a fantastic comparison of their features.
Very few vendors actually support the Mac, although a number of them do keep posting news and press releases that they are making one or launching one soon.

This may be a reason why many doctors over the years would want a Mac, but would’nt get one due to the lack of Medical Softwares for it.

In the interest of the majority of doctors reading this, lets ask the questions: “What does one mean when they say that their EMR is natively supported on a Mac? What exactly does it take for an EMR to be supported on a Mac ? What is this native thing I’m talking about”

For an EMR to be natively supported on a Mac, it must be able to be used by a Mac User while the program is running ON the Mac. The program’s code must be understood by the Mac –> The program’s code must speak the Mac’s language and follow the Mac’s set of rules. Windows has its own set of rules and they are different from a Mac. So a program made for Windows unfortunately may not run on a  Mac.

The Mac and the Windows are inherently different, and a software program built for one may not run on the other as the other operating system might not understand what the program is trying to say/do

For an EMR to natively run on a Mac, its underlying code must be understood by the Mac, and it must be following the rules of the Mac.

Smart question asked by Dr Vivek Patkar when I was explaining this above concept to him: Nrip, does this mean that if I have a software made for the Mac, and I can make Windows understand it, then it will run on Windows.
 
This is true and is the underlying reason why the virtualization industry is a boon and is bomming.  A Virtual Machine is a type of software used to create a Virtual Environment, which is referred to as Virtualization. Virtualization may be used to run multiple operating systems at the same time on one Physical Machine. Through the help of a virtual machine, the user can operate software built for one Platform (Or Operating System) on another.

This brings us to a Grand Realization. A SOFTWARE NEED NOT BE NATIVELY SUPPORTED ON A PLATFORM TO BE USED BY IT ANY MORE, AS LONG AS YOU CAN USE A VIRTUAL MACHINE WHICH ALLOWS YOU TO USE IT ON THE INCOMPATIBLE PLATFORM.

Here is a link to 2 fantastic Virtual Machines for the interested. As always, feel free to drop me a line at n.nihalani AT plus91.in for any help.

Virtualbox

VMWare Fusion

In recent times, whether it is due to Apple’s advertising or the Word of Mouth spread that works with Doctors, a Number of Indian Doctors have told us that they are buying a Mac; and if the Clinkare EMR would be supported on it. Yes of Course! Both the desktop version and the SaaS version are supported on the Macs.

Talking of Saas, this category of SaaS and Web Based EMR’s is exciting. THEY ARE USUALLY PLATFORM INDEPENDENT, UNLESS THERE IS A PC COMPONENT WHICH REQUIRES NATIVE SUPPORT: LIKE A SCREENSHOT PLUGIN, OR A VOIP COMPONENT, OR A DICTATION COMPONENT;

In this article on MAC EMR Software, Houston from Software Advice states “Web-based EMRs are the best long-term investment for doctors using Macs. Unlike their on-premise counterparts, vendors offering web-based software won’t have to support two versions of their software (i.e. one for Windows, one for Mac) in the long run ”

One can’t agree more. Every Web Based EMR vendor, knows that their EMR can be used using a Windows , a Mac, a Ubuntu; Users can even use the EMR’s on Tablet PC’s as well as Low Cost Netbooks.

There has been a surge in the adoption of the iPads in many health care institutions(pictures below), here in India, and as reported in the United States, United Kingdom and Singapore. iPads with their form factor well suited for use by On Round Doctors in In-Patient Wards, Nurses while taking down Vitals in Charts and even Assistants in OT’s for Managing Checklists are a hit. 

LabC: Pathology EMR on the iPad

Dr Bhosale trying the Clinkare EMR on her iPad

        
With Virtualization being available and Web Based EMR’s being the popular flavor with vendors, there are now choices available to Physicians and Clinics for Medical Software which can be used with their Mac’s.

If you are in the United States, you may want to use this comparison to help you select the Web based EMR which works best for you

If in India, you really should give the Clinkare Physician EMR a try ...

Want to acquire an EMR Vendor: Look out for these points:

Considering the Electronic Medical Records space is heating up across the globe, and in India too in the coming 5 years there should be some Big Groups like Reliance entering it, lets look at what a Corporate Biggie looking at entering the EMR space via an acquisition should look for in an EMR Product.

The guys at Software Advice linked me to this very interesting article on their site by Austin on Intuit and a possible acquisition by them in the Health IT segment and requested a few added opinions on the same. http://www.softwareadvice.com/articles/medical/intuit-health-1042511/

Since Austin has done a fantastic job at listing the qualities Intuit should be looking at in an EMR Product for acquisition, lets list them out before going further:

• Low price point product -
• Dead-simple UI -
• Friendliness for cash-based practices -
• Web-based deployment -
• Large market share / brand name -

In case the strategy is to go after Physicians and 1-3 Member clinics as mentioned in the article, most of these points are a given. The price point being low should not be an important factor in case there is a substantial subscriber base of Physicians - the eventual target market.

I'll look more at things to cover which if not looked at can and will lead to issues in the future:

1. Is it just an EMR or does it also help a physician do his job better? 

There must be enough reason for a Phsyician to use this EMR as against pure digitization of records. Here is a list of a few features that help Doctors run their practice more efficiently:

• What Patient Safety features are provided?
• Are there Medico Legal Safety features to protect doctors against suits?
• Does it allow operation for patients as an EHR ?
• Does it allow Physcians to export Clinical Statistics and Trends which can be used in Presentations, Research papers or simply better planning.
• Does it offer Administrative advice like a Hospital Information System does?
• Can it generate Email and Text Messages alerts, Birthday and Anniversary Reminders, have some CRM functionality.
• Can the doctors, nurses and staff have Intra-Team chats via the product.

(This list is compiled from requests by doctors who have been using an EMR for a minimum of 2 years)
One point which I'd also like to add is Does it interface with 3rd party PHR's or Patient Portals?
 

2. How does the EMR vendor provide training and after sales support? This is an important factor which directly influences the percentage of Physicians which will stay on with an EMR vendor in the long term. 

• Does the EMR vendor have a ticketing system?
• Does the EMR vendor allow issues to be reported via the Phone to a person?
• Does the EMR vendor provide Live and Online Support?
• Can the EMR user simply email the issue with possibility of attaching a screen shot?
• Does the EMR vendor have a Dedicated Training and Help portal with html and audio visual Training Aids?
  
• Does the EMR vendor provide a DVD with audio visual aids for Training?

3. How does the EMR vendor collect feedback and feature requests. Health Care IT is still a nascent idea irrespective of the billions being pumped into it. As the user base grows, the improvements and feature ideas that this increasing mass of users provide will change how EMRs are built and function over time. If the EMR vendor you pick does not do it, some one else will.

P.S. Plus91 runs a Pain Point Analysis program for Physicians in India and we get almost half a dozen ideas each month. Every 6 months we go through that list of ideas to evaluate which of them should be the next feature to put in. This program lets us "Help Doctors Help Us Help Them". Look for an EMR vendor who has been listening to the users and has a dedicated process to solicit and collect feature feedback and requests.

4. How consistent is the EMR firm with regards their Business Model?
Different EMR firms have different Business Models. Comparing Practice Fusion vs AdvancedMD on a parameter like Subscriber Base doesn't make sense. Some have short terms models directed at Sales, other look at Recurring Revenue via SaaS and Value Added Offerings, while others look at real long term offerings based on Data Mining and Trend Analysis. Whatever be the model, consistency is important.

5. How future proof is it: The EMR and the Vendor? 
Its important to look for an EMR company which is thinking ahead and is building its products influenced by the future. Look for mobile friendliness and features for a smart phone offered by the EMR, Does it have a smart way of integrating Social Media while following privacy norms.

6. Flexibility ???:  Flexibility may mean ability to modify the UI, enhance the product features, add newer modules. Physicians and small practices usually don't have their requirements clear and these do end up varying over time. A flexible EMR permits additions and modifications to be made quickly in the future. Look for an EMR product which is flexible, modular and offers the scope for improvement. Note, that this is a very tough ask in spite of how simple it sounds. Too much focus on flexibility can easily lead to a non-product.

Useful Links:

Technology For Doctors

Physician barriers to EMR Acceptance 

A Blog on EMR and EHR

Prayers for Japan and Learnings for everyone on the benefits of National Health IT Policies

The past few days have involved almost all of us praying for Japan which was ravaged by a severe earthquake and tsunami. Japan's most powerful earthquake in 140 years struck the north-east coast on March 11^th 2011, triggering a massive tsunami leaving behind many homeless and stranded. (Information and Situation Report from WHO)

As we continue praying for hope in Japan, we are also learning all we can about how disasters can impact the way we live and seek to improve. Sadly, Japan now faces severe logistical problems and with the latest news on the mishap at a nuclear reactor, the situation only seems to be getting worse. While Japanese officials have more pressing issues on their hands, a problem that will arise as time progresses will be that those left alive may find themselves without their medical records. Natural disasters wipe out everything — including paper medical records as well as computer and communication networks.You can setup the network again, but you can't bring back the paper.

In this time of national crisis, it would have certainly been helpful for Japan to have a robust Healthcare IT network in place. A collaborative one where it is easy to share data, which is securely backed up redundantly in multiple locations that would leverage geographical diversity as a means of countering nature’s unpredictability: Geographical Division Multiplexing if you please;

While Japan does have a Healthcare IT strategy setup, with benefits and stimulus funds, it is relatively new and yet to mature. Health data digitization and Electronic Record Keeping is still in its infancy. Japan does not boast of large scale Electronic Medical Record coverage.

Wouldn’t any country ride out disasters better with health data sharing in place? This should be taken as a wakeup call as well as a learning lesson by all nations which haven’t yet devoted time and money to setting up Nationwide Health IT Infrastructures.

India for one must be looking at learning from this.  Having a Nationwide Health IT Strategy should be treated as important as a Tsunami Alerting System (TAS).  Purists will argue that a Nationwide Health IT System is not intended for alerting and helping contain situations like the TAS. And they are not completely wrong. 

In many cases it has been observed that long term benefits are eventually forgotten. Instead, this concept of “Long Term benefits” must be replaced with Pre-planned Goals which must be “Sought” on maturity of a model.  Now, any system can provide a set of benefits directly on implementation, and an additional set when it has matured.

Similarly, the use case of using a Nationwide Health IT System for predicting and alerting requires a certain amount of usage at first.  A sophisticated and mature Nationwide Healthcare Network built using technology can identify the emergence of possible pandemics. Trends in symptoms can help identify risk areas, and collaborative diagnosis can help is sharing treatment plans and improving them.

One must understand that if maturity of a network is required for additional goals and since that takes time, one must seek to implement early. 

Links of Interest

WHO Page on Environmental Health in Emergencies

WHO page on Myths and Realities in Disaster Situations