Tag: enki EHR

16 Apr 2016

Update on remote healthcare delivery from Michigan to Sri Lanka


I wrote earlier about an experiment in remote healthcare delivery – in which medical students from University of Michigan (under the guidance of an Ann Arbor-based physician Naresh Gunaratnam, MD) are working with an eldercare facility in Sri Lanka (Grace Care Center) to manage health of 40 patients via a virtual, group consult every other week. Here’s what we have learnt so far.

Key Takeaways

1) A group consult is very effective, even emotionally. Unlike the private nature of healthcare delivery we are used to in the developed world, a group consult can actually be highly effective – even emotionally. It helps patients realize that others are sick too and they are not alone. This somehow converts the group consult into a more supportive environment that can possibly increase patient compliance.

To describe a group consult, a patient in Trincomalee, Sri Lanka sits in front of a Skype camera and interacts with doctor(s) in Ann Arbor, Michigan while other patients wait in the background and observe. The doctor(s) go over key vitals, past history, medication list, dosages and examine latest data available and note what’s changed from the last time. They ‘look’ at the patient via Skype, ask questions (some general) with the help of a translator/ medical assistant on the Sri Lanka side. Naresh and the medical students arrive at a consensus on what to do and then they move on to the next patient.

2) One hour together is a lot of time. When a group of doctors go over each case methodically for a group of patients, a lot is actually accomplished. Time is saved. There’s a unique sense of transparency – everyone knows what is being done. Unlike in private practice medicine, there’s a different sense of teamwork among the doctors and among patients. Learning occurs both ways.

3) The mind can’t really tell the difference. Video-conferencing even via a blurry medium (in this case Skype over a moderately paced Internet connection) is very effective. Patients (and doctors) forget after a point that no one is physically in front of each other. The doctors aren’t located in a formal office – in fact, some are on their bed, some in their studies, some in their kitchen. This provides a different sense of camaraderie and in a completely different way they are welcoming the patient into a personal space. After the initial minutes, the mind actually forgets what’s virtual and what’s real. The patient-doctor interaction can get as immersive and real as a video game.

4) Using evidence-based guidelines. Given the age of patients, the focus of care has been hypertension, followed by diabetes. Readings are captured by the assistant every other day and entered into the system. We are now programming enki EHR using JNC 8 guidelines for hypertension to automatically assist during care based on age and medical background of the patient. During the group consult, the guidelines keep care-givers in check based on evidence-based protocols. The evidence-based methodology provides great balance to the human interaction enabled through a virtual consult.

4) Medical devices that aid remote healthcare delivery. From blood pressure monitors to glucometers to stethoscopes, there are now several Internet-enabled devices that can “show” you the data via the Internet.Quantified Care demonstrated via the Smartphone Physical a variety of devices that could be used to conduct a physical exam remotely. The most interesting device out there is Scanadu Scout that captures a variety of physiological readings (several times a day if needed) through a tiny sensor-filled machine. We are exploring the use of remote monitoring devices to further our experiment.

5) Sometimes, virtual is better than the real thing. This past week, Naresh shared the outcome of a short survey done amongst patients. They feel well taken care of and actually prefer ‘virtual care’ over a real one. While this may be early, it’s startling and very telling. But when you think about it, it’s actually not surprising. For some patients, the alternative to ‘virtual care’ is usually bad care or even no care.


Why this is the future and could change how healthcare is delivered

Every few decades, medicine undergoes a big shift – increasing access, life expectancy and so on. We are in the middle of another one – where medicine is becoming a more precise data science. There’s increasingly more data available about the human body – from a gross level (# of steps taken in a day to # of hours slept) to a deeper level (DNA testing to microbiome testing). Doctors are increasingly reliant on data (usually via lab tests) before making a medical judgment. Most data is always available via a patient’s electronic medical record. The ‘Internet of things’ is a very real trend (think, the Nest thermostat) and is becoming the ‘Internet of medical things’ where medical devices are Internet-enabled. Patients continue to live longer through the aid of medications and fixes at the hospital. Fewer and fewer doctors are getting into primary care where the basic flow chart of a patient’s diagnosis begins. Cost of care will continue to explode (even in the developing world) as science advances further within specialties and the influences of regulation, administration, insurance companies and law continue to rise.

The trends point to a world where access to quality and reliable healthcare will not just continue to be difficult but may also increase. The trends also point to a possible future where healthcare is accessible from anywhere through a mobile Internet connection with the aid of virtual consults and medical data through an EHR.

By Praveen Suthrum, President & Co-Founder, NextServices.

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

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

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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