The Official Omedix Blog

I read a fascinating article in Wired Magazine this month.  It talks about how back in the day, a company would issue a crusty old press release to announce news that it wanted its clients (and maybe others) to hear — new service announced, new revenue milestone reached, new partnership formed, whatever.

But today, as far as I’m concerned, the press release is basically dead.  It’s been replaced by the blogosphere.  Why read the “official” press release from a company when you can read the “real deal” behind the scenes as written about by bloggers who have no vested interest in the company?  Or as written about by an individuals within the company versus carefully crafted by a PR team?  Don’t we place infinitely more value on the opinion of an impartial third-party than the official company line which is obviously going to be biased?

I think the simple answer to all these questions is “Yes.  Transparency is pretty darn attractive in a company.”

So, as President and Founder of Omedix, I’ve made an executive decision: Omedix will become a transparent company.  Not a RADICALLY transparent company (a term bandied about in the Wired article) — after all, I don’t plan on putting the personal lives of myself or any of my colleagues out for public consumptions, but we’ll be a REASONABLY transparent company.

What does that mean, exactly?  It means that I’ll make a concerted effort to write a blog post here at least every eight weeks or so.  It means that I’ll cover pretty much any significant event — whether it’s positive OR negative.  It means that the unavoidable “What is Omedix really like?” uncertainy experienced by every single client who’s considering working with us just went down a whole bunch of notches because when they Google “Omedix” they’ll be led straight to this blog where we’re, well, transparent

Disclaimers Disclaimers Disclaimers  

Okay, so the realities of business do requires us to impose some limitations on this.  For starters, anything told to anyone at Omedix in confidence (whether by a client or business partner) will never be posted on here.  No one will ever have to worry that by talking with me about something sensitive (or simply not appropriate to be blogged about) that they’d see it written about online later that day.  That would be betraying people’s trust, which takes years to earn and minutes to lose.

Second, I would estimate that no one will follow this blog more closely than our competitors (I actually have a funny story about that phenomenon; be sure to ask me sometime).  Anyway, that means that as much as I’m excited about certain initiatives, I have to be a little careful about what I write here. 

That’s pretty much it.  I figure we’ll make the rest up as we go along, being sure to place trust of our clients and business partners as our first prioirty.

Okay, So Let’s Get Started!

With all the formalities out of the way, let’s get going already!

Transparency Topic #1: Operations

One of the area we’ve been working on quite a bit lately is operations — how fast can we pump out a great-looking, well-built website?  Where can we cut the fat from our process?  Omedix building websites faster is a win for everyone since clients wants their sites ASAP and we can’t bill for the full site until it’s done.

One of the things I’ve been realizing lately is that we have to calibrate for how much the client wants to be involved. At one end of the spectrum, we have the client who basically wants us to just do our job and deliver the site.  The less interaction, the fewer meetings, the better.  For this client, we make a lot of assumptions, get deliverables to the point where they’re in a position to be evaluated and approved, and then move on.

At the other end, we have the client who wants to be involved in EVERYTHING.  We actually haven’t had too many of those, but these clients like to get into the nitty-gritty of how we do things, and really dive into our work at the process level.  To be hones, it’s a more time-consuming process than the “just tell me what I need to do and let’s launch the site” client, but I can still respect that they’re passionate about their site (which is a good thing). 

I suppose this is no magical revelation that embodies the spirit of the pioneering transparency in Omedix, but it’s a start, and I think I”ll get the hang of this after a few posts.

Incidentally, if there’s something you’d like to see me write about, you can contact me through the Omedix.com website.  Just click “Contact Us” and submit an online inquiry, and ask that it be routed to me.

Thanks for reading!  Most sincerely,

Josh

It’s interesting to see how society adopts new ideas and services. Let’s take a look at Search Engine Marketing. This is such a no-brainer promotional opportunity for a medical practice that targets the general public it’s almost laughable. A comparison is in order:

	THE YELLOW PAGES What You Get: Assuming your purchase, say, a quarter-page ad, you get, well, a quarter-page Yellow Pages ad, maybe in color, located in the section that makes sense for your practice What It Costs: For the above-described ad, roughtly $7,500 - $10,000/year (as I understand it) Value Proposition: You want people to find you when they need your services, and people find things using the Yellow Pages…well, at least they used to
	SEARCH ENGINE MARKETING What You Get: When people search for keywords that suggest they may be a good candidate for your services, your website shows up in the results What It Costs: Depends on if people actually click on your ad. If no one ever clicked on your ad, you literally pay $0. If 1,000 people clicked on your and and you bid $0.25/click, you pay $250. Assuming those rates hold for 12 months, you’d pay $3,000 for 12,000 visitors to your website you wouldn’t have otherwise gotten. Value Proposition: People who need your services reveal themselves via their search engine queries and you pay money to “advertise” to those searchers, except that you only pay when they actually view your site

RUNNING THE NUMBERS

So, you can pay about 1/4 of what you’d pay on the Yellow Pages for maybe 60 times the amount of traffic? Let’s translate that into numbers.

Let’s say I’m a Primary Care Physician and one new patient is worth, on average, $350 to me (that’s a very conservative estimate). Let’s say 50% of the visitors to my website are prospective patients. Let’s say 5% of all prospective patients who visit the site actually sign up with me. Let’s say I receive 12,000 visitors a year.
That means that for my $3,000 investment in Google I get back:

[$350 per Patient]*[12,000 Site Visitors]*[50% are prospective patients]*[5% enlist with me] = $105,000 in additional revenue

And if we figure out the Return-on-Investment on that:

ROI = $105,000 - $3,000 / $3,000 = 3400%

WOW. Can you imagine, a 3400% return?

BUT ONLY A MINORITY OF PRACTICES DO SEARCH ENGINE MARKETING

And yet, every single medical practice in existence goes with the Yellow Pages because “that’s the thing to do” while only a handfull of progressive physicians does Search Engine Marketing. That’s craziness!

There are some nuances to this. For example, how do you make sure you really are converting 2.5% of your visitors? How do you measure that? What keywords do you target? So, it’s a no-brainer investment (in my opinion), but not necessarily a no-brainer operation. Anyways, it’s just interesting to me when I see practices lay down thousands of dollars for brochures or sponsorhips, when that same money could be used so effective with Search Engine Marketing.

I’m here in Park City, UT for the sixth annual Information Therapy Conference. For the uninitiated, Information Therapy is simply the idea that Patient Education can be as “therapeutic” as medicine itself when exactly the right information is delivered at precisely the right time.

For example, one physician here at the conference said that after she delivers bad news to a patient, she figures the patient retains maybe 25% of what she tells them if that. Information Therapy is about recognizing that this patient is at the step “just diagnosed with Heart Failure” and then making sure that patient receives an article, watches a video, or is otherwise educated about “You’ve been diagnosed with Heart Failure. What now?”.

Conferences like these are interesting because you meet so many different people from so many different areas of healthcare each tackling a similar problem from a vastly different angle.

For example, I’ve seen Patient Portals here from three different companies each selling essentially the same core Patient Portal to three different markets. If it happened that a patient’s insurance company purchased the Trizetto portal, his hospital purchased the MedSeek portal, and his doctor purchased the Omedix portal, he would have three different ways of accessing almost the exact same thing!

I’ve seen an incredible demonstration from MedEncentive on Pay-for-Performance. Traditionally, I haven’t been blown away by Pay-for-Performance, but they’ve set up their program in such a way that patients are actually financially incentivized toward compliance, doctors are financially incentivized to follow Evidence-Based Medicine, and both parties are aware that their actual performance will be rated by the other party (Matthew Holt does a much better job of explaining this on The Healthcare Blog).

One theme that seems to come up every single year at the Ix Conference (hidden though it may be) is that medicine practiced in an Integrated Health Sytem (like Kaiser, Group Health, Cleveland Clinic, etc.) has some serious advantages and incentive alignments versus the standard “private practice” model. Seeing the EMR and Patient Portal that the Cleveland Clinic has in place makes me teary-eyed, and another doc here admitted it makes him “drool with envy.” So maybe part of our job is to take the magnificence of a Patient Portal / Patient Education Infrastructure as seen in an Integrated Health System and make it available to a private medical practice? Or at least to adapt it to better fit the needs of that market, but still enable them to achieve that nirvana?

Other interesting trivia at the conference:

• What billion-dollar healthcare industry are most doctors not even aware of? Disease management. Crazy stuff.
• Healthwise is starting to get very sophisticated with its Patient Education. They are actually able to now generate patient education content specifically for the moment in time when a patient has been diagnosed with asthma but has not demonstrated compliance. WOW.

And finally, I’m starting to realize just how a big of a deal patient education can be for patients. In fact the phrase “Patient Education” doesn’t event really do the concept justice. Information Therapy on the other hand is huge. When patients are empowered and encouraged to learn about their own condition, they do learn about it. And when they learn about it, they are actually able to monitor the care they receive, to interact with their doctor in a more elevated and more efficient manner, and they are so much happier because they don’t just blindly meander through the healthcare system; they actively navigate it.

The trick is distilling all of that down to a concrete value proposition for a standalone medical practice. Is it enough to say “We offer patient education.”? Is it enough to just encourage patients to look at it and leave it at that? I don’t think so. I think the graph of Patient Education Utility looks like this:

In other words, you don’t get a whole lot out of the Patient Education if it’s just there, but if you really use it, integrate it, engage with your patients, etc. it can make a huge difference.

More thoughts to come down the line!

Earlier this week I met with a professional HIPAA consultant. The purpose of the meeting was to review our products & services and make sure that everything we’re doing (and want to do) is HIPAA-compliant.

My job requires that I have at least a basic understanding of the different requirements of being “HIPAA-compliant” but this was an opportunity to get real confidence about exactly what has to be done to slap the “HIPAA-compliant” label on our services. What’s amazing to me is that it’s not that hard to officially list out what needs to be done to be HIPAA-compliant, but the government has done a terrible job of making it clear.

After many consulting hours and questions, I can summarize all the complexity of HIPAA as follows. Oh, and this list is for commentary purposes only; I very well may be missing information here. That having been said, here we go:

(1) HIPAA really stands for Health Insurance Portability and Accountability Act and has two “Titles”. When everyone thinks of HIPAA, they really only think of Title II: Administrative Simplification

(2) “Title II: Administrative Simplication” gave rise to five “rules”, only two of which most of us have to worry about — the Privacy Rules and the Security Rules

(3) The Privacy Rules are handled by the Office for Civil Rights within the Department of Health and Human Services and are officially outlined one-by-one here. The only relevants parts for a practice appear to be Part 160, Subpart C (talks about how you might get audited) and Part 164, Subpart E (talks about what you have to do and what patients’ rights are).

(4) The Security Rules are handled by the Centers for Medicare and Medicaid Services (CMS) within the Department of Helath and Human Services. Those rules are officially outlined here. There is a huge amount of text that doesn’t apply to most people, but the good stuff is in Part 164 and is broken down into Physical Safeguards, Administrative Safeguards, and Technical Safeguards.

(5) The rules are very open-ended, saying things like data should be encrypted but leaving open-ended as to which encryption algorithm you use. That means that being “HIPAA-Compliant” is not a certified stamp you earn when you pass a rigorous inspections. Rather, it is a self-assigned description that your organization thinks that it’s made a reasonable best effort to comply with HIPAA. In other words, “HIPAA-Compliant” really means, “we took a look at HIPAA and did the best we could.”

(6) And finally, there are a bunch of non-official templated HIPAA contracts or agreements that are floating around — Notice of Privacy Practices, Privacy Policy, Business Associates’ Agreement. These agreements aren’t official, just based on the stuff above.

And well, that’s it! As I understand it, that is the entirety of the complexity of HIPAA as it relates to an ambulatory practice and by extension a healthcare IT vendor. In my opinion, the government has done such a terrible job of making that clear. I could take two days and set up a website called “The Official HIPAA Resource Center” and leave out things no one cares about like legislation that was proposed and rejected. Because no one has setup a simple-to-use resource center, an entire industry of HIPAA consulting exists that capitalizes on people’s fear.

The reality of HIPAA is also that it was drafted not by clinicians, but by legislators who consulted experts on healthcare. So there is a ton of stuff in there that is a total pain to do. And for Healthcare IT vendors like us? We get a huge amount of latitude as to how we choose to implement HIPAA and apparently “HIPAA-compliant” varies quite a bit.

So, those are my thoughts on HIPAA. Patients should absolutely have privacy and security with their medical records, but the implementation of how that’s legislated leaves quite a bit to be desired. For someone not in the industry, this article must have been incredibly boring. But for the healthcare people, you probably share my frustration with this.

I just finished speaking with a researcher doing a report on the market for the different services we sell, and it instantly became clear to me how problematic these reports are.

When I worked for GE Healthcare (at the time called “GE Medical”) the marketing department would have a fun time disparaging the expensive and ultimately totally inaccurate reports they received on the various markets.  What was amusing was that these reports would estimate the total market size, but sometimes that size would be lower than GE’s sales alone!

I didn’t have a sense at the time of why these reports were so bad, but now I do.  Let me count the ways:

(1) Zero Incentive to Contribute Good Information
So, I was asked questions like “what do you think will drive the market in the future?” or “what do you think practices will be looking for most when selecting this product type?”.  I certainly have my thoughts on that, but why would I want to effectively publish my strategic thinking by revealing it to a researcher?  What benefits do I gain from doing that?  If anything, I expressly do NOT want this information published because it’s potentially helpful to competiting companies. 

(2) A Strange Expectation that My Time is Worth $0/Hour
Maybe this falls under the incentives issue, but when I asked about how I was being compensated for my (presumably valuable) time I was told that I could receive a free preview of the report and that sales people would then follow up with me to see if I was interested in purchasing the report.  Huh? 

(3) What benefits do I receive from participating?
Again, this could fall under the incentives issue, but, honestly, what benefit do I receive by participating?  The only benefit I did see was that I get to ask the researcher my own questions about the market since he’s been speaking with everyone, but don’t these issues apply to them as well, so do I really trust the information?

At the end of the report’s development cycle, it will be sold for somewhere in the neighborhood of $15,000 to medical device companies, pharma companies, private equity groups, and the like, and will serve as the basis for investment decisions (I suppose) in various companies.  But it’s whacky information…so…is it even a net positive influence (versus a net negative influence)?

We’ll see what happens when I get my free preview.

I spoke earlier today with a large multi-doc specialty group and the physician described their current website as “vestigial.”  Although I was aware of the meaning of the word, his comment takes on added humor and depth when juxtaposed to the dictionary definition:

ves·tig·i·al (v-stj-l, -stjl)
adj.

1. Pertaining to structures or organs that were well developed in an organism’s ancestors but have become rudimentary or degenerate during the course of evolution.

We all got a good laugh out of this one.  There are definitely benefits to serving the physician market.

I wish I could point to a news article or URL on this story, but this one is purely through the grapevine. 

Earlier today I spoke with a HIPAA Compliance Expert who recently received a phonecall from a chiropractor on the East Coast.  This chiropractor apparently offered online patient registration on his website — a feature which clearly represents Protected Health Information under HIPAA.  One of his patients noticed that the registration form on his website was not encrypted…

Apparently, the patient complained directly to CMS, and CMS has now asked the chiropractor to produce his HIPAA security plan (one of the elements required by HIPAA) within 30 days or else face fines of up to $100/violation capped at $250,000 and possibly jail time.  Yikes!

I’ve seen no shortage of practice websites that have these violations.  It will be interesting to see if news of this gets spread, and if so, how that affects people’s anxiety about HIPAA.

Wow, we just got back from the BONES conference (the largest annual gathering of orthopaedic practice managers), and talk about a success.  We met a ton of practice managers and learned what they’re looking for in their sites.  Now comes the hard part: following up with everyone in a reasonable time frame.

Conferences are funny because you’d think that Vendor A has as good of a chance as Vendor B to meet people that might be a good fit for their services.  You’d think.  In reality, we got pretty lucky by having a *great* booth location:

What exactly does “great booth location” mean?  Well, if you look at the illustration above (click to zoom), the purple arrows (drawn by us) represent the flow of traffic.  In the hopes of applying otherwise useless knowledge, I even made these arrows “vectors”, which is a fancy way of saying that the length of the arrow indicates how much traffic flowed in a particular direction.

As you can see, people naturally walk in and talk to the first vendors they see.  Then they branch out, but they get distracted along the way.  Maybe they see a friend, maybe they see food; who knows.  Either way, the “flow” of traffic decreases considerably with each row down that you go. 

Our booth was well-positioned because we were on the corner of the main thoroughfare, and also — and this counts as proof that luck matters as much as anything in business — the vendor across from us bought up four spaces, and had a wide-open area, meaning our bright purple-colored booth could be seen from the back of the hall.

Once we get our pictures together, we’ll upload a picture of the booth itself.

At any rate, this rather fortuitous flow of traffic meant we got to meet *lots* of people, and hear from them what they were looking to do with their sites.

There was nothing really surprising.  I’d say maybe 90% of practices have a site.  Among those 90%, I’d say 75% haven’t thought about their site in the last year.  Among the 25% that have thought about their site, I’d say 50% are unhappy with what they have.  Thus, our target market = 10% (the people who don’t have a site) + 90%*75% (The people who have a site but haven’t thought much about it) + 90%*25%*50% (the people who have a site and thought about it, but aren’t happy with their current vendor) = 89% of all practices.  WOW.

It’s not that our competitors are bad.  In fact, I would honorably say that our competitors produce decent-quality sites (not quite Omedix sites, but well, that’s another posting).  I think what’s really happening is that most practice managers just haven’t looked into their websites and how they use the Web in their practice.  Interesting stuff.

Anyways, so we’ll be busy following up with people and seeing what kind of new innovations are out there.  Of particular interest to me was the growing interest in patient education (finally!), and the nascent interest in practice intranets.  There are lots of cool solutions, there, so we’ll have to figure out the best way to set something up.

Thanks for reading!

 Josh

So, when we first started out, our mentality with clients was: When they call for update requests we’ll gladly make the requested changes, but it’d be silly to call up clients and create more work for ourselves.

Well, fast forward a few years and I realize that’s a pretty lame customer service mentality to have — basically doing only what’s necessary to prevent your customers from being unhappy.  Yikes!  So, we changed things up a bit, and in fact, in the last few weeks, we’ve begun living, doing, and promoting a new way of approaching our client relationships.

We figured most practices think they ought to be on the Web, they know they ought to make use of it somehow, but they really don’t want to sit down and learn HTML or learn all the detailed strategies for how one promotes, etc.  Maybe they’d like to know the high-level stuff and they’d like to see what’s possible, but then they’d kind of like to just have it done.  Over time, something tells me that while a physician is taking care of patients he’s not quietly thinking in the back of his head “oh my gosh, I need to update my website!” 

And so we started to realize that for a lot of our clients, either we contact them to recommend some site changes, or nothing happens.  We realized that they’re not being irresponsible; it’s just not #1 on their list.  We realized that, frankly, it should be our responsibility to keep these sites fresh and up to date.

The Evidence Stares us in the Face…

I give you Exhibit A:

This is my own father’s cardiology practice, as viewed on April 11, 2006, and their latest news is 9 months ago?  (By the way, if you’ve wondered why we always promote this site, read my personal explanation) In fact, they’re actually about to purchase one of the new CT/Angio machines.  Now, they’re doing it because this is a more powerful diagnostic technique, it’s less risky to the patient, and it allows them to be more proactive about treating heart disease, treating patients before they end up with a heart attack.

So, they may or may not have the idea to post this on their site.  But while this development is brewing on their end, we should be planning our periodic “is there anything we can update?” phonecall to them anyway.  When we call, they can tell us all about this, we can gather the necessary images for them, and, boom, they’re site has now been updated!

And It Gets Better, Too…

There’s something else going on here, too.  The CT/Angio is basically a tool for screening patients at risk for heart disease.  So, this is a way that they can grow their practice (bringing in new patients for screenings), it generates additional follow-up business for them in some cases (when a patient is found to have mild atherosclerosis and requires a proactive angioplasty), and all the while they’re doing a service to the world by making our community healthier. Everybody wins.

But how will people know they can do this unless they promote it?  And of course that’s where we come in. 

Patients visit the site — maybe from the search engines, maybe from a friend’s recommendation — they read about how they can get screened, they fill out the online appointment request form, and boom, we’re done.

There’s another thought, too — If their site looks out of date, people are unlikely to return.  If their site appears to be updated frequently, people will return to read what’s new.  I visit iHealthBeat every single day because, well, they update it every single day.

In the Process of Getting This Going

Doing all the proactive “what can we update for you?” sounds great, but, operationally, let’s be honest, it’s a challenge.  Suddenly we have created [# of clients] * [time it takes to contact each client] every [how often we contact our clients] months.  So we can’t just do it and celebrate, we have to really plan this out.

We’re in the process of doing that now, but I know it’s the right way to offer our service.  We’ve already started doing this with some of our clients, and we plan on doing it with every new client, so we’ve already begun promoting it this way.  I’m eager to hear your feedback on this, so let me know what you think of this!

Josh

For a bunch of Internet-addicted web designers and programmers, it sure took us long enough to get our blog up and running.  But it’s finally here!

So what kinds of things do we plan on covering here?  Well, we’d basically like to answer the question “How can a physician practice make the best possible use of the Web?” 

There was a time when that question had a boring and uninteresting answer because there just wasn’t that much technology available.  But today things are different.  There’s online video, patient education, search engine marketing, great programming languages for developing cool personalized systems, and lots of other really exciting things.  Plus, integration with other healthcare IT systems (EMR, Practice Management System, PACS, etc) is starting to become a reality (the details on that one are for another blog posting).

For myself, personally (this is Josh writing), my father is a tech-savvy cardiologist, my sister is a pediatrician, my brother-in-law is an obstetrician/gynecologist, and I’m an entrepreneur and computer programmer so it’s pretty gratifying to see how my skills/interests apply to their lives!

There’s something else we wanted to do with this blog.  Companies today are different than they were 10 years ago.  Back in the day, companies were closed, mysterious entities whose true workings was the stuff of legend and myth.

Today, companies like that appear almost silly.  People now expect honesty and transparency.  The Web just makes it too easy to communicate so why fight the tide instead of embracing it? 

So perhaps most of all, this blog is us being who we are as we further hone our skills as Web Professionals for Medical Practices, and as we ourselves figure out how we can do a better job of what we’re doing.  I’ll probably be the author for most of these posts (no one else seems to like writing anything but code!), but we might have some guest contributors from time to time (I can think of some Omedix clients who might be game!)

Thanks for taking the time to learn about us, and we look forward to writing more!