Category: EHR

09 Apr 2016

Our latest updates on Becker’s ASC


1. NextServices Showcases Solutions at Digestive Disease Week 2014
(GI Endoscopy-Driven Surgery Centers to Know 2013) NextServices announces endoscope integration with enki EHR at DDW 2014.
2. How Do GI Coding Changes Affect the Field? Reimbursement, Technology, Denials & More 
(ASC Coding, Billing and Collections) Praveen Suthrum, president and co-founder of NextServices, explains what the 2014 changes mean for gastroenterologists and GI-driven ambulatory surgery centers.
3. How to Boost Clean Claims Submission at ASCs 
(ASC Coding, Billing and Collections)Nextservices blog post outlined on how ambulatory surgery centers can achieve 95 percent clean claims submission ratio.

4. Sending Patient Statements: Tips From NextServices 
(News & Analysis) In a recent blog, NextServices provided the most effective methods for sending patient statements in order to see results.
5. 11 Esophagoscopy Code Updates to Know 
(ASC Coding, Billing and Collections) Gastroenterology coding changes.
6. Collect From Patients: Best Practice for Sending Statements 
(News & Analysis)NextServices recently posted an article about sending patient statements on their blog. The article discusses whether providers should send patient statements daily or in bulk.
7. NextServices Exhibits EHR Through Google Glass 
(News & Analysis) NextServices announced it has unveiled the prototype for enki Glassware at FutureMed in San Diego.
8. Futuristic Healthcare: 7 Considerations for Ambulatory Surgery Centers 
(ASC Turnarounds: Ideas to Improve Performance) Praveen Suthrum, president and co-founder of NextServices provides a look ahead for ambulatory surgery centers.

09 Apr 2016

An interactive colon cancer screening blog


The website, helps patients find ASCs performing colon screenings and also helps doctors refer patients for colon screening. Colon cancer can be prevented by removing polyps in the gastrointestinal tract. According to, there’s a 90% chance of survival when colon cancer is detected early.

Ambulatory surgery centers can direct patients to this interactive portal, especially those turning 50 – the age when it is recommended that people screen for colon cancer. ASCs can become affiliate centers by registering on the site.

09 Apr 2016

Digitally engage patients – your most under-utilized resources

Digitally engage patients

Medical practices continue to hesitate to share records freely with patients. There could be many reasons for such caution. Patients could use the information to sue doctors when something goes wrong. Doctors templatize information – and therefore, when someone reads it, it may not make much sense. But what if we trusted patients to do the right thing? We trust them to use the information to take better care of themselves? And we teach them to do so. Then we could get a lot back in return – not just clinical returns of healthier patients but patients could also engage better with ambulatory surgery centers and specialty groups to lower administrative costs.

Here are a few ideas where patients could help doctors lower administrative costs for the front desk and other staff members.

Patients could:

  • Update their demographics and insurance information through a web portal
  • Upload images of insurance cards, driver’s license and social security via a patient portal into the EHR
  • Read and sign consent forms
  • Pay past dues
  • Take clinical satisfaction surveys
  • Complete clinical questionnaires

Patients are the most under-utilized resources in a care setting – if we trust them enough and engage them, everyone would win.

09 Apr 2016

Why doctors should value the data in their EHRs?


Medicine undergoes shifts every few decades – from germ theory to medications to reliance on clinical trials. During the past decade, there’s been a slow but steady shift towards reliance on data. Nearly every treatment plan has associated tests – radiology tests, pathology tests and possibly DNA and microbiome tests in the future. Doctors rely on data to confirm their hunches and to also protect themselves from law suits. Over the next decade, the amount of data we will get from a patient’s body is going to be enormous – akin to the amount of data we are now generally exposed to everyday as consumers. According to Marty Kohn from IBM’s Watson, 90% of the world’s data was created in the last two years and 1 trillion connected devices are generating 2.5 quintillion bytes of data every day (quintillion is 1 followed by 18 zeroes).

Doctors have a dual relationship with data. On one hand, they use it clinically for treatment (e.g. lab tests) where the data is of high value. On the other, when they document medical charts – they enter minimal information and enter standardized information (e.g. an operative note – almost no one reads this). The main reason for this polar relationship is because they aren’t visualizing the use or the value of the data that they put in. They don’t combine and use it as a whole to analyze their patient population. They don’t use it to predict future outcomes. In the future, they will.

Medicine is gradually migrating from an art to a more exact science. IBM Watson has been trained by senior oncologists at Kettering Institute to assist in diagnosing patients. If these trends are amplified, it might not be so difficult to imagine that a part of medicine could even become a data science – where algorithms analyze data from inside (e.g. DNA tests) and outside (e.g. activity trackers) and present findings to a doctor, who then reviews and confirms a diagnosis. If this were to become even remotely true, the value of data in medical charts would go up. So may be we must pause for a moment to consider what we put into a medical chart everyday.

By Praveen Suthrum, President & Co-Founder, NextServices

09 Apr 2016

Why these are still early days of healthcare technology


A couple of decades later, when we look back at this time, we would more completely understand that these were the early days of healthcare IT. While majority of Americans are just about getting on digital records, large pockets of the world are largely paper-based. While most of the hospitals in the US are using hospital management systems, almost no one takes a cloud-based approach. While several medical practices are migrating to the cloud, just a minority uses a mobile platform. While large healthcare systems have figured out how to implement and use an EHR, almost no one uses the medical record as a means to deliver healthcare. While early adopters are getting access to data from their insides through DNA and microbiome tests, most doctors aren’t yet accustomed to using this information to diagnose before a disease occurs. While several families use Skype to talk to loved ones, they have never used video calling to speak to a doctor.

There are 7.2 billion people in the world today, majority of them in urban areas. There will be 1.75 billion smartphone users in 2014. It’s easy to imagine that in just a few years, most of the world will be connected via smartphones that are Internet-enabled. It would be a failure of our health systems, if we don’t take advantage of this reach to provide healthcare access everywhere.

09 Apr 2016

How to get patients to save you time via an EHR’s patient-portal?


Despite requirements mandated by Meaningful Use Stage 1, providers are still hesitant to actively share their medical records with all of their patients – they possibly fear trouble with law suits. But I’ve met doctors not only are able to share their records with patients confidently (because the records are not templated and the care is thorough) and even get patients to participate actively in managing their health. Patients tend to respond by understanding their conditions better and I’ve noticed that they proactively rate such doctors highly on forums such as Going beyond such benefits, there are also business benefits by engaging patients over the Internet. Using a well-functioning patient portal, ambulatory surgery centers can save time for themselves.

Invite patients to use a patient portal – a common area that providers can share medical records, including lab results, medications, operative notes and so on. Once patients use the portal regularly, have them periodically track and document basic vital signs such as BMI, blood pressure, insulin readings. Have them complete checklists, scoring sheets (e.g. such as a Crohn’s Disease Activity Index), manage their demographic information, scan driving license or update photographs. This would save enormous amount of time for the front desk and nursing staff of the surgery center or medical practice. As a doctor, explore having virtual meetings for return visits through the patient portal. Your patients would greatly appreciate the time you’d save them by willing to have a virtual conversation.

The next logical step for the surgery center would be to actively monitor care across groups of patients via a dashboard that collates data from the patient portal. Using such information, clinical staff can track health across a group of patients and when things seem to deviate from the norm (e.g. high BP for 3 continuous days), then the practice can call the patient to schedule a check-up proactively, even before they fall sick. This reverses the expectation that patients need to call a doctor after they fall sick.

By Praveen Suthrum, President & Co-Founder, NextServices

09 Apr 2016

Why we chose a typewriter for our ad?


I think it’s a good thing that we work in an industry that’s in transition – we get to see the extremes and these could become stories to recount later. At sessions at FutureMed (now called Exponential Medicine), I recall extracting my own DNA and experiencing firsthand the role that data from DNA might play in the future of care. And on the other end, I visit medical practices that run really old software with archaic interfaces.

The typewriter is the quintessential icon of bygone technology. It opened up a new era in the industrial age and created countless jobs. But upgrading a typewriter doesn’t make it different. This reminds me of present day software. The original EHR systems did a great job in creating the market for digitized records. But simply documenting medical records electronically is not the end of the road – it’s the beginning. The real story occurs when we do something interesting with the data that we store.

We chose a typewriter for our ad in Becker’s ASC to call out all the software upgrade requests that salespeople extend to doctors and administrators. An upgrade is usually more of the same – it doesn’t change the basics. What we are calling for is a change – a new way to look at EHRs and management systems for ambulatory surgery centers.

By Praveen Suthrum, President & Co-Founder, NextServices

09 Apr 2016

How to use an EHR when you can’t type or click?


Yesterday, I demonstrated enki EHR to one of our billing customers. In passing, I told him that someone else used a transcriptionist on our platform by creating limited-use logins – after listening intently, he told me that might be the perfect idea for everyone like him who disliked operating a computer in front of patients. It made sense. As a senior gastroenterologist, his time is better spent with patient care than with a computer. But that doesn’t mean that they cannot benefit from an EHR – the most powerful benefit from a mobile-based EHR is that he can pull up a patient record even in his car (if he wanted to). It’s accessing patient information at the right time that brings meaning to implementing an EHR.

Here are other ways you could use an EHR without needing to operate a regular computer:

a) Use an iPad/ Android-based EHR where you can tab your way through patient information – if you are comfortable with tabbing.

b) Integrate Dragon Medically Speaking and speak your way into the EHR.

c) In front of patients, use the iPad to access information just as you would use a paper file. Pull up vitals, chief complaints, medication lists, document basic data such physical exam and review of systems. But don’t document the History of Present Illness, Assessment and Plan. Write the final plan on a piece of paper and have your staff complete the final part of the note for you – on their computer. The iPad and computer would sync and keep the medical note current.

d) If you are used to using a transcriptionist – continue doing so. Create a separate login (with limited use) for the transcriptionist so that he/ she could login to the EHR and complete the note for you inside the patient chart.

e) Use a template for repeatable consults and teach your staff to edit key areas of the Note.

f) Use a combination of the above – when needed document (e.g. for complex cases) but for the common ones, continue practicing as you are used to and letting the system, process and staff take care of computer-based documentation.

However, you will need to go through the chart, approve and digitally sign before a Note is complete. Go ahead and start using the EHR – the benefit of giving better care to your patients will outweigh the hurdle of getting started.

By Praveen Suthrum, President & Co-Founder, NextServices

09 Apr 2016

Should hospitals explore Google Glass now?


We have been Google Glass Explorers (as early adopters are called) for several months now. We extended enki EHRto Google Glass – to provide basic medical information such as patient’s name, basic demographics, vitals, medications, allergies and endoscopy images. We did the pilot primarily to explore and understand how it would feel to use Glass in a clinical environment. We demoed this prototype at FutureMed 2013 (now called Exponential Medicine).

At the outset, Glass is futuristic and feels very, very cool in a medical setting. Sooner or later, physicians will see patients without being occupied with a computer. But as a hardware with accompanying Glassware (what its software is called), it has its share of teething problems. The hardware heats up when a lot of data is exchanged. The software SDK is not simple enough to work with. There are several important features that are missing. However, it’s still very important for the medical community to explore how it may be used.

We are having early conversations with health systems where the discussions are usually about finding the right longterm use cases. The question that senior management at hospitals must ask themselves is actually whether they would like to experiment with wearable computers at this point or not. Every technology breakthrough occurs through a series of failed and successful experiments – at the end of which, the organization/ team can establish a strong point of view based on what they have experienced. This allows them to build the future.

For example, Google Glass may not be ready for a full-fledged rollout in the stage that it is – it’s at best suitable for a prototype amongst early adopters within a single department of a hospital. But the fact is the hardware will improve and may be within a year, it will get to a point where it becomes solidly reliable for a full-fledged rollout. But for a hospital to be ready for such a rollout, it must be willing to experiment today and be willing fail – so that it can succeed when and where it matters – in defining the future of healthcare delivery.

By Praveen Suthrum, President & Co-Founder, NextServices

09 Apr 2016

Experiment in remote, virtual care – Michigan to Sri Lanka


Last year, I went to Trincomalee on the east coast of Sri Lanka to volunteer at Grace Care Center, a wonderful orphanage and center for elders run by a friend and colleague Naresh Gunaratnam, MD from Ann Arbor, Michigan. I was part of a small group – we were mostly alumni from University of Michigan (from medicine, law, finance and business backgrounds) and one from Texas. Naresh suggested that we experiment with remote healthcare delivery/ management by rolling out enki EHR at the Center.

When an eye-camp was organized, we went through documenting medical charts of children from Grace and nearby orphanages electronically on enki. It was an interesting start because in a very short amount of time, we trained five or six senior kids at the home to start using the EHR. Two kids captured BMI, another documented demographics, and one girl Karthika (in the picture) who was training to become a dental assistant entered all the medical information. Each resident at the home had a paper medical chart documented previously by doctors volunteering/ visiting from University of Michigan. Over 2-3 days, the children and their local teachers entered all the information they had into enki – including medical data of the elders at the center.


A few months later, when I was in Ann Arbor, Naresh called me over one Saturday morning to watch a group Skype call. I saw 3-4 medical students in their respective homes, elders from Grace in Sri Lanka participating in a remote medical consultation under Naresh’s supervision. Someone who knew Tamil (the local language) would ask patients questions and translate – about pain, symptoms, behavior and so on. Then there would be a discussion amongst the group with Naresh asking the students probing questions. There were often references to previously documented electronic records of the patients. During an hour+ long call, one patient after the other received medical care remotely from Ann Arbor to Trincomalee. Everything was electronically documented in enki EHR. It was very satisfying to see remote healthcare delivery in action on a software that we created.


This morning I was pleasantly surprised to be copied on an email that the students were mailing each other – it said ‘enki training video in Tamil’. One or more of the medical students from UM made a basic video on how to document medical records in enki EHR in the local language, Tamil. Here’s that video.

Professor C.K. Prahalad (from whom I learnt anything I needed to learn from a business school – all outside of class) often used to talk about weak signals that would give a glimpse into the future – these usually amplify over time and become dominant trends. I remembered him this morning. On the face of it, the experiment in Sri Lanka may seem like a simple video conference, followed by documentation of patient records, training of medical students and localization of a software program. But it gives a peek into the future of how medical training could be imparted and how healthcare could be delivered – remotely, virtually, without regard to location, perhaps on demand. Electronic health records are really not an end in themselves – they are simply the building blocks that would allow for treating patients anywhere, anytime with the aid of data.


Further reading: Update on remote healthcare delivery from Michigan to Sri Lanka

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