Mac Forum / General / General / July 2009

"Who's on first?"

I dunno.  The damn computer blew up.  I think it was running an MS
Service Pack update at the time, although it could have been those
yellow things hanging in the air in exactly the same way that bricks
don't.  Either way, the poetry was horrible.

jt

Okay, that sounds logical, because a moderate sized practice would be
unlikely to get by with just  _one_  license for a $5,000 version
of the software.

Figures.

MacPractice can handle writing to the most popular EMR and EHR
Windows forms, but the difficulty arises when Windows users try
writing back to MacPractice, I believe.

Naturally, Windows medical apps have no reason to even acknowledge
any existence of MacPractice, because they already essentially "own"
the medical  EMR/EHR  market.

Apparently MacPractice has already grabbed a chunk of that market,
will be interesting to see if they can grab more.

One thing that held MacPractice back was they had no  _quick_  way to
"speech dictate"  into the fields of EMR forms.

That changed as of a month ago, MacPractice lost no time advertising
that "MacPractice MD" will work with "MacSpeech Dictate Medical"
for filling in EMR/EHR by voice, instead of typing.

Problem is MacSpeech still has to be handled carefully, like a vial
of nitroglycerin.

Below is a radiological extract I dictated into MacSpeech Medical
recently, with 100% raw accuracy, no text or punctuation
corrections whatever.

MacSpeech still very rough around the edges, only works
that well in the hands of people like me.

For example, because of the "NewLine" bug (medical only,
bug absent in the standard non-medical version) - - -

I had to do the awkward workaround of dictating the original
file as one long line, then throw the file into BBEdit and set the
hard line-breaks at 48 character for the below example.

...otherwise the NewLine bug would have capitalized the first
letter on every line.

- - - start radiological extract dictation example - - -

Spinal Cord - Radiation Damage

The post-irradiation lower motor neuron syndrome
neuronopathy or radiculopathy?

Bowen J, Gregory R, Squier M, Donaghy M.

Department of Clinical Neurology, Radcliffe
Infirmary, Oxford, UK.

It is not known whether the post-irradiation
lower motor neuron syndrome results from
radiation damage to motor neuron cell bodies or
from damage to the nerve roots of the cauda
equina. ... The first reported neuropathological
study... was performed in one patient who died.
This showed a radiation-induced vasculopathy of
the proximal spinal roots, with preservation of
motor neuronal cell bodies and spinal cord
architecture. These clinical, radiological,
neurophysiological and pathological findings all
point to a predominantly, but not exclusively,
motor radiculopathy affecting the irradiated
portion of the cauda equina proximal to the
dorsal root ganglia. Radiation exposure exceeded
40 Gy both in our series and in previous
reports. The natural history of this disorder is
one of relentless deterioration occasionally
punctuated by 1-2-year periods of stability.
Post-irradiation lumbosacral radiculopathy is a
more accurate name for this condition.

- - - end radiological extract dictation example - - -

Mark-

The clinic where I work has been through multiple iterations and several
nightmares over this sort of software.  It's a horrible field lacking in
open standards and cloaked in proprietary bullshit (leading to the data
from one system not being portable to a new system, and once not being
portable between updates of the same system).  We have spent hundreds of
thousands of dollars in the past decade on this.

Medical billing is ridiculously complex at the best of times.  Our
billing situation is complex because we offer a huge spectrum of
services.  We've got 90+ clinicians providing services in one or more of
five clinic locations, plus clinicians going out to nursing homes, board
and care facilities, assisted living facilities, group homes, regular
homes.  We have fee-for-service patients and patients seen under county
contracts.  Some insurance companies pay a capitated rate, some pay
fee-for-service.  It's not unusual to have to send out three to five
bills to payor sources who each pay a portion of the bill.  Different
payors pay at wildly different rates and we are on the hook for tracking
and refunding overpayments.  We have thousands of patients at different
levels of care and sometimes seeing several clinicians concurrently.  
Different insurance companies require bills submitted in different
formats (our system has to be able to submit bills to dozens of
insurance companies with 100% accuracy; since these are usually batched
submissions, a mistake kicks out the whole batch).

A single payor system.  Wow.  For providers, life could be *so* much
simpler with a single payor system.  Only sending out one bill per
service, to one place, using one data format.  It costs $2-3 to send a
bill out; a single payor system would cut our billing costs at least in
half (that by itself would save us over $150,000-175,000 a year in labor
costs; multiply $2-6 by the total number of billable patient services
performed each year in the US and you are talking real money).