Smart Technology at Your Medical Practice

To narrow down the most common ICD-9 codes his physicians use, each of which will have five or more corresponding codes under ICD-10, Regional Urology CEO Joel Young eschews heavy coding books and complex software programs.

Instead, for the past few months, Young and his staff at the Shreveport, La., multi-location practice have been tapping into the intelligence of a smart ICD-10 analytics program, Navicure's ICD-10 Analyzer.

With just a few mouse clicks to input claims data, Young only has to wait a few seconds to have full view of the 20 most common codes his doctors use - and the dozen or so more-specified, possible codes they'll have to use starting Oct. 1, 2014. In turn, he's also able to see how those codes can affect reimbursement.

"It's deceptively simple, that's the best part about it," says Young. "I can put in one physician's clinic, and be able to analyze that clinic specifically for where we're going to have trouble with ongoing codes. You can easily tell that this one code may have 10 to 15 options, so we can drill down ... we can instantly see, 'This doctor's got five codes with 10, 12, or 15 translations, so we need to spend more time [training] on those.'"

The analyzer is just one example of "smart" technology - a category of computing technology largely defined as technology that does something above and beyond the usual, such as smart text messaging, in which an embedded program corrects misspelled words as you type. Smart technology holds the promise of improving efficiencies and productivity. At Regional Urology, the smart code analyzer has already saved three to four hours of ICD-10 research, per physician.

Here's the latest, greatest, and smartest stuff that could, and should, grace your clinic in the coming months and years.

Smarter check-ins

Ready to say goodbye to patients waiting in long lines when they arrive at your office? Or perhaps your front-desk staff is sick of trying to wrestle copayments out of their pockets? As check-in technology evolves, in-person check-ins with front-desk staff could truly become a thing of the past.

"There's a reason why the airlines went to the kiosk," says Medical Group Management Association consultant Derek Kosiorek, who works with medical practices. "You can give your information and there's a lot you can do right there. We're going to see a lot more kiosks in the medical practice waiting room. Practices can do real-time adjudication with the insurance company to determine what the copay is going to be, before the patient goes into the exam room, or check insurance eligibility. We're finding that kiosks often pay for themselves in a shorter amount of time than expected."

Voice recognition 2.0

Voice-recognition technology, which has boomed since CMS rolled out its EHR Incentive Programs, is pretty smart today, turning statements and conversations into text that can be placed into practice notes. But what it generally lacks is the ability to take the information a step further, into actionable items.

And that's where it's going, much to the joy of physicians who feel EHRs have taken a toll on productivity.

Smarter voice-recognition technology will allow for you to move beyond just dictating into a machine. So, for example, if you talk about ordering a prescription, that information will be generated for your review, and you will be able to place an order for that medication automatically.

"It's a move away from a typing-with-your-tongue approach to something more actionable that drives next steps," says Juergen Fritsch, chief scientist of M*Modal, which creates voice-recognition technology for physicians. "A lot of efforts that are being directed right now are in healthcare IT to come up with technology [that] can interpret the voice and drive the actions from it."

Kosiorek says he doesn't think it will be too long before voice-recognition technology can collect text generated from entire exam-room conversations.

"Part of the doctor's pain point is having to enter information into the EHR," says Kosiorek. "Voice recognition is going to get to that point. But that's a few years out."

Fritsch, however, says he doesn't see that application of voice recognition panning out.

"The problem though is that physicians don't say the same things to their patients that they document in their EHR afterwards," says Fritsch. "If you have a very obese patient and you really want them to lose weight, you're not going to say that the same way to the patients as you are going to put into the record."

Wearable tech to monitor patients

The next level of in-home monitoring devices, which patients take on and off to measure variables such as blood sugar levels, and then transmit that information to the doctor, is actual wearable monitoring devices that collect and transmit data to physicians. And the market is booming: International market research firm ABI Research projects wearable medical devices will reach 100 million units by 2016.

Some examples of devices patients can wear might include wrist devices that measure steps or sleep patterns, or shoe insoles that measure distribution of weight and gait.

"It can trigger the practice to call the patient and say, 'we're seeing abnormal numbers here,'" says Kosiorek. "There are a lot of wearable things that simply transmit, via Bluetooth, information back to the medical practice."

Physicians are also wearing smart technology.

Internal medicine physician Nick Patel of Columbia, S.C.-based Midlands Internal Medicine, swears by his Littmann digital stethoscope and EKG monitoring glove, both of which allow him to more easily gather information and transmit it into his Cerner EHR, by way of Bluetooth, and his Microsoft Surface tablet.

The stethoscope, which Patel has used for about three years, takes sounds to a new level.

"It has noise-canceling earbuds; it takes all the ambient sounds out, so I'm able to concentrate on the heart and lung sounds a lot better," says Patel. "I've picked up on murmurs I've never heard before, especially with patients with COPD."

The device also allows him to record sounds to share with other physicians or students, and sync those sound recordings with a computing device.

More recently, Patel started using the EKG glove, a disposable glove that allows him to measure patients' EKG levels remotely. The glove, which is placed on the patient's chest, remains there for 48 hours and sends a wireless signal to his computer.

The glove is currently approved by the FDA but is still in prototype form (Patel only obtained it because he has a relationship with the company developing it), but Patel says he's already reaped several benefits - including greater ease of use over the traditional electrode-based measurement system, and less worry about bacterial infection resulting from applying EKG leads to patients.

"Essentially, you can walk into CVS one day and say, 'I just want to see how my heart is looking' and a cardiologist can give you a cardiac age and tell you if you have a normal EKG or an arrhythmia or if you need to see a doctor right away.'"

For a slideshow on smart devices such as these, see "Six Smart Devices for Physicians and their Patients."

The closest thing to an in-brain chip

Speaking of things physicians can wear, perhaps the sexiest smart technology on the horizon - and one that deserves its own classification because of its multidimensional aspects - is Google Glass. Created by Google and its technology partners, Google Glass is a set of eye glasses with an optical, head-mounted display (currently under development). While wearing the device, physicians can record conversations, take photos, and see information such as patient vitals, disease history, or even recent patient events that have been documented in the EHR."Google Glass can project information that only you can see about the patient," says Kosiorek. "You can look at the screen while you're looking at the patient. Let's say I have a patient with a lesion on his skin. I can take a picture of it. Then, you can overlay the first picture on top of the [latest] picture to see how it's changing."

While the $1,500 device is in the prototype phases - developers are still working out kinks such as overheating and battery life - Fritsch expects to see physicians taking interest in the next few years.

"It's an interesting device for healthcare professionals in general because it allows them to do things hands free, while working with patients, without having to do something on a device," says Fritsch, adding that M*Modal is part of the development community working on medical applications for Google Glass. "It's a companion. It doesn't replace any other device ... but it augments [physicians'] experience by providing them a different way of getting information."

Marisa Torrieri is an associate editor at Physicians Practice. She can be reached at marisa.torrieri@ubm.com.