System
Overview
MedInformatix
provides physicians and associated healthcare workers with a comprehensive on-line
charting application. The software allows healthcare providers to share and
pass data electronically and instantaneously at the actual point of care with
less effort and better efficiency than the traditional paper-based method.
The software handles all patient charting and forms typically found in the healthcare
setting and its open architecture allows for easy customization. The software
also offers an integrated Windows billing application as well as an integrated
Windows scheduling application providing a complete clinical and financial paperless
application. All three modules may function independent of each other. The software
operates on a hand-held, light-weight, mobile, electronic pen tablet or PC.
MedInformatix is a pioneer,
forging the way through this new and exciting electronic charting frontier,
ushering physicians away from the historically flawed large mainframe systems
of the past and into a new millennium whose foundation is built upon open architecture,
Client/Server technology, Windows NT, Microsoft SQL and wireless technology.
The software’s strength has been proven in hundreds of practices nationwide.
Re-engineering the Historically
Flawed Systems of the Past
The
unique integration of functions found in this software product allows for the
implementation of a work flow process not previously possible with the older
generation of medical systems. This provides an opportunity to reengineer the
historically flawed workflow method so often found in the traditional paper
practice. Under MedInformatix software
reengineering concept, the walls between the front-office (reception), providers
of care (doctors and nurses), and the back-office (billing and collections)
are electronically dismantled. The entire staff of the practice is able to use
one computer system with a central data repository of patient medical and accounting
records. For this workflow concept to work, the software must be inclusive of
all levels of users. MedInformatix allows this through an original first of
a kind “hierarchical tree” user interface in the software. This makes it exceptionally
easy to use even by computer illiterate staff. This interface, however, does
not sacrifice the capability to handle the doctor’s most complex data processing
requirements.
Company
Recognition
MedInformatix’
product was one of six technologies that was referred to by Bill Gates in
his keynote address at the annual HIMSS meeting in San Antonio, Texas. A
video of a clinic using the MedInformatix application was introduced and referenced
as a good example of the new direction the healthcare industry is headed.
The product has also been featured or mentioned in a wide array of healthcare
and entrepreneurial publications including: Medical Software Reviews, ACP
Observer, Family Practice Management, U.S. News & World Report, Healthcare
Informatics, Los Angeles County Medical Association, Health Data Management,
EyeWorld Week, OBGYN Management and Managed Care Technology.
MedInformatix was also
nominated by Microsoft as an unprecedented finalist in three separate categories,
encompassing both clinical and financial applications, at the annual Microsoft
Healthcare Industry Solution Awards in August of 1997 in Las Vegas, Nevada.
In 1998 MedInformatix again learned that Microsoft had chosen the software
as a three time finalist and again encompassing both EMR and financial nominations.
MedInformatix was the only company to receive multiple nominations. In December of 1997,
Health Technology Management also announced MedInformatix a winner of its
“What Works” award. The magazine studied various EMR packages as they worked
in actual physician practices and announced MedInformatix its winner. The
case study itself can be found in the Magazine’s December, 1997 issue. MedInformatix
was again nominated in two separate categories for Microsoft’s Healthcare
Solution Awards encompassing both financial and clinical categories.
The Software
Modules
The
backbone of the entire software package is called the Decision Information
Manager (DIM). This program is the engine which provides most of the functionality
of the entire system. Other software modules may provide various user interfaces
but when some function is needed to be performed, it is DIM that is often
called upon to provide the service. DIM controls the patient medical record
completely. When a user interacts with DIM to review or create or alter a
medical record, he usually does it through the hierarchical tree interface
called the Decision Tree. “Decision trees” are set up normally to be snapshots
of procedures, workflow, and decision flow charts for a medical practice.
Typically these are designed to fit specific types of practices but can be
easily modified to fit a single installation.
The MD Workbench is a “front-end” user interface used to
find patients. It is often called the Scheduler because that is its most used
function. It has a broader purpose, however. Whereas DIM controls access to
individual patient records, MD Workbench controls access to many patient lists.
These lists can come from Schedules, Messages, and Orders. The use of MD Workbench
is optional. One can access the patient records directly through
DIM. However, only
MD Workbench provides the ability to control office workflow by allowing the
management of different patient lists or “Views”.
The Accounts Receivable capability
of the MedInformatix is built into DIM. The actual transaction entry of charges
and payments occur in DIM.
However, some capability is provided
by additional modules. Actual billing of insurance is done by another module
-- MedInformatix Printing Module. This program imports the claims from DIM
and allows printing of insurance claims and processing of electronic billing
to Medicare, clearing-houses, and other carriers. Reporting capability is
provided by a set of Crystal Reports. These can be further customized by
users who possess the Crystal Reports Report Generator.
The
Charting Software
The pivotal feature of MedInformatix’ application is known
as the Decision Tree. The Decision Tree user interface provides a revolutionary
and unique way for users to interact with a computer. The tree interface is
characterized by an expanding set of choices that start out with a small set
of main choices which then further branches out to finer and finer choices.
These choices are picked out by double-clicking options on the tree.
This approach suits the logic of
workflow in Medicine very well since often, activities are performed based
on a progressive and ever changing set of choices for every patient. The decision
tree, as the name implies, guides the decision making flow and then at an
appropriate branch on the tree, some action can occur, or some reminder may
appear, or some data entry activity may be required. Everything that a user
will do will always depend on the structure of the decision tree.
The decision trees are not fixed
routines. These are changeable entities which can be altered to fit the characteristics
of a medical practice. Where possible, MedInformatix has preconstructed decision
trees to fit some specific specialties of medicine. A user may still modify
these preconstructed trees to further refine them for unique characteristics
of a practice.
The decision tree, as the name implies,
guides the decision making flow and then at an appropriate branch on the tree,
some action can occur, or some reminder may appear, or some data entry activity
may be required. Everything that a user will do will always depend on the
structure of the decision tree.
The basic structure of a tree is first based on the hierarchical
arrangement of choices. Main choices often break up into sub-choices (or branches)
which give finer options. These choices in turn can launch another tree which
can then start up again with main choices. This flexibility allows practically
unlimited expansion (although this requires a lot of planning).
The choices themselves will not have
any significance unless some action is triggered upon reaching an appropriate
end-point. These actions are assigned to particular tree branches by giving
these branches a “property”. Property is a word often used in Object Oriented
programming and it has great application with this decision tree concept which
in itself is an example of an object oriented programming language.
The decision tree is in fact a programming language that
has been simplified greatly for use by non-programmers. A programming language
allows a user to control how the computer works which is exactly what you
do when you design a decision tree.
The Billing
System
The
MedInformatix’ Billing System is integrated into the charting system and it
uses a paradigm that is unique from any other traditional practice management
system. The primary interface of the user for entering charges is the Decision
Tree, the same interface used to generate progress notes, orders, and other
documents. It is intended to be used as a “point of care” entry tool and is
best done by the actual health care provider providing the service (i.e. the
Doctor, Therapist, Nurse Practitioner, etc.) This ensures less errors and
less redundancy when passing data from person to person.
The
system assumes a team effort between all the
users. The front desk is assumed to be responsible for entering patient demographics
before the patient is seen by the physician. The physician would then be responsible
for entering normal evaluation and management charges (E&M) and for ordering
and billing other services. The nurse may be responsible for billing the
non-E&M services such as lab tests and injections if the nurse is the
one who verifies completion. This flow ensures error free transfer of information
to the provider to the printed claim.
Unlike the workflow enforced by typical billing systems, a “Biller” position
has a unique function when using the charting software. The Biller takes on
the role of an auditor and spends less time on data entrybut more time on
quality. This person may also be the one to provide feedback to the various
providers to correct errors from lack of training or understanding. The biller
is able to correct claims from a master screen called “Generate Claims”. But
rather than checking out individual claims, a biller will spend time auditing
items which have a high probability of
error, such as specific CPT codes, or specific users. The feedback provided
to the error producing individual will assure future reduction in errors.
In the environment existing today, Providers filling out
fee slips are often not given any feedback when errors occur. Often intermediate
personnel step in to correct errors thus adding extra resources to the process.
Also, in a typical paper environment, fee tickets are lost, charges are left
unbilled, and billers invent diagnosis codes to use. This common scenario
explains some of the inefficiencies in administration of most practices.
Insurance payments in the MedInformatix
Solution are applied on a charge “line item” basis. In fact, a detailed historical
record of payments and adjustments to each line item is retained. Guarantor/Patient
payments are made on a line item basis as well but can be automatically applied
from oldest to newest. This level of detail may prove to be an additional
workload to those practices who do not currently pay by line item. This system
uses this methodology because the current environment demands that physicians
know historical payment patterns by specific procedure. This is often required
when negotiating or evaluating managed care contracts or verifying profitability
of specific payor business (such as Medicare or Medicaid). If the practice
already applies payments by line item then it will find the technique used
in the charting software to be easier. The charting software uses sophisticated
techniques to automatically determine if secondary carriers are to be billed,
what amounts are to be written off, or when the patient becomes responsible.
This eliminates the potential mistakes made when billers make complex decisions
at the time payments are entered.
The claims printing module called
the MedInformatix Billing Module is a separate program from the charting software.
It reads a claim file generated by the charting software and then prints any
number of claims. Although the extra step of exporting and rereading claims
could initially be considered an inconvenience, the Billing Module is a mature
product that has been handling all complex varieties of printed claims for
five years. The extra step is taken only by the computer and does not involve
any significant interaction on the part of the user.
