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Medical MIS goals include efficiency, better patient care
Today’s management information systems (MIS) surpass scheduling and records management with the added benefit of data-sharing features.
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NEWARK, N.J. — Just as ophthalmologists aim to improve their surgical outcomes by heightening the efficiency of the procedures they perform, they are implementing cutting-edge information management software and hardware to improve the efficiency of their practices. Buzzwords like database, documentation and data sharing were once the domain of computer programmers and software developers. Today, only the most antiquated physician expects to maintain a growing practice without the efficiencies afforded by computerized, integrated records management, scheduling and electronic claims filing.
Telemedicine applications
One of the newest systems is the Nidek Advanced Vision Information System (NAVIS), which runs on Windows 98. NAVIS combines the traditional functions of an information management system, such as records management and scheduling, with telemedicine applications via its ability to interface with Nidek’s NM-100 Portable Digital Non-Mydriatic Fundus Camera. The NAVIS non-mydriatic fundus camera is being beta tested in the ophthalmology department of the University of Medicine and Dentistry in New Jersey.
Chairman of the Ophthalmology Department, Marco A. Zarbin, MD, PhD, a NAVIS user, said, “Eventually we’ll be able to screen every single person who goes into a doctor’s office — or even in a mall. We could get a 100% screening rate of diabetics, because while they’re in the internist’s or endocrinologist’s office, a picture of their eye could be taken. The benefits of increased screening are that the patients who end up in the ophthalmologist’s office will be mainly those who have a real probability of having something that needs to be treated. This is one of those innovations that is going to decrease the cost of health care eventually,” he said. “I’m quite sure this is how [all] screening will happen in the future. This is so much cheaper and so much more efficient. This technology makes it possible to get a fairly good view of a fairly large surface area despite the fact that the pupil is not dilated,” he said.
Among the Nidek instruments that can be connected to the NAVIS system are the 3Dx/NMV and NM-100/D fundus cameras, the AR-600/600A and ARK -700A autorefractors, the LM-970 and LM-970 and LM-990A lensometers, the SL-1600 and SL-250 slit lamps, the RT-2100 refractor, the NT-2000 and NT-3000 tonometers and the US-2500 (B-mode) and US-3300 (B-mode) ultrasound equipment.
A major benefit is its open architecture, which affords the ability to network to other manufacturers’ technology, as well. Some non-Nidek equipment that can be hooked up to the NAVIS system includes fundus cameras like the CR6-45NM/f from Canon, the Kowa VX-1 and the Zeiss FF450. Among autorefractors are the Canon RK3/RK5+, the Humphrey HARK599 and the Tomey AR1000 and RC1000. The Humphrey LA350 and the Tomey TL 1000 lensometers can be attached. The specular microscope SP series by Konan and the Tomey EM 1000, as well as the confocal microscope ConfoScan2 can all be linked to NAVIS.
Choosing wisely
NAVIS is one of the few information management systems with features specifically applicable to ophthalmology, but there are numerous medical information management and practice management systems and software packages whose manufacturers and distributors are eager to compete for your information technology budget.
Idaho Eye Center Director of Information Technology, Craig Bates, says a realistic information technology budget is upwards of 10% of a practice’s profits. Mr. Bates provides the know-how necessary to negotiate software and hardware purchase and upgrades, and to keep 40 workstations and five file servers up and running at Idaho Eye Center’s three locations, including two ambulatory surgery centers. Mr. Bates recommends that a practice of that size have an on-site technician, even if there isn’t enough work to keep the technician busy all of the time. “In my case, [in addition to maintaining the network and our information system needs], one day a week, I run our Nidek excimer laser for laser in situ keratomileusis surgery. Doing the technical work and calibration for the laser represents 20% of my time,” he said.
Practices that have 50 computers and five to 10 file servers definitely need a full-time information management person because of all of the networking involved, he said.
“At the very minimum, when people are looking for a practice management system, I push them to deal with somebody [e.g., consultant] for information technology they can trust, somebody whose role is not to sell them anything and somebody who will strictly be there to help them look at the technology side,” said Mr. Bates. “What I mean by the technology side are things like the back-end database, where the data are stored and how it will operate over certain types of remote communications [lines] for networking. The vendors usually push whatever makes their systems look the best, but, a good share of the time, you’re not going to need the super high-end servers or the super high-end workstations. Yes, it will make their system work faster, but you usually don’t need all that,” said Mr. Bates.
“At the minimum, you need to bring a non-vendor ‘IT’ person on board while you’re doing your evaluation and probably while you’re doing the installation. When you’re looking for a system, talk to other people who’ve bought systems,” said Mr. Bates. “But don’t just talk to the owner or the person who made the purchase decision, because there’s going to be some pride of ownership issues there. Instead, talk to the receptionist and the billing staff, and see what they think of the system, too.”
One of the main things that Bates tells physicians to watch out for when shopping for information management products is software-licensing fees. He says no matter what price the vendor states, “negotiate, negotiate, negotiate.” The four most common methods of pricing for software licensing are by “seat;” by "type of user’" by “concurrent users;” and by “site.” Licensing by seats means the vendor charges a licensing fee for every workstation or computer in your practice that has access to the program. Licensing by type of user means that a different fee is applied to different users, such as one fee for receptionists, one fee for physicians and another fee for billing staff. This method can be quite cost prohibitive, said Mr. Bates.
Licensing by concurrent users is his favorite and the method that he negotiated for Idaho Eye Center. “We did a study and figured out that 15 of our 40 workstations typically access our information management software at any given time, so we negotiated a licensing fee that allows only 15 users to access the system simultaneously. However, all users are ‘registered’ on the system. So in our case, licensing by seats would not be a good option, and it normally is not a good option. Some of the vendors push that because they get more money that way,” he said.
Another common method is licensing by “site.” This means one licensing fee is applied to the entire practice. With this method, the vendor will usually charge a monthly or yearly fee, so you never stop paying for it; whereas with the other methods, the fee is usually built into the sale price.
For Your Information:
- Ron Kaiser can be reached at Nidek Inc., 47651 Westinghouse Dr., Fremont, CA 94539-7474; (510) 226-5700 or (800) 223-9044; fax: (510) 226-5750; e-mail: ron_kaiser@Nidek.com.
- Craig Bates can be reached at Idaho Eye Center, 2025 East 17th St., Idaho Falls, ID 83404; (208) 524-2025; fax: (208) 528-8198; e-mail: tritec@ida.net.
- Marco A. Zarbin, MD, can be reached at the University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Dept. of Ophthalmology, 90 Bergen Street, 6th Floor, Newark, NJ 07103-2499; (973) 972-2036; fax: (973) 972-2068.
- John Meek can be reached at Suppleye.com, 1861 Deepwood Drive, Akron, OH 44313-4945; (330) 923-5071; fax: (330) 487-0212.