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Twenty years ago, Neil Notaroberto was an accomplished and well-paid computer programmer. He liked his work and he enjoyed information technology, but sitting in an office all day was, at best, not his proverbial cup of tea.

Then, through a project affiliation with the Oregon Health & Sciences University, he gained the opportunity to spend substantially more time with physicians, a career choice he had considered earlier in life, but one that lost out to computer science. One neurosurgeon in particular impressed him, and Notaroberto thought, "This guy is making a difference in the world. I need to do that."

Today, Neil F. Notaroberto, M.D., is a solo practitioner and ophthalmologist. His EyeCare 20/20 practice enjoys two practice locations in Slidell and Harahan, La. Immediately after the Oregon experience, Notaroberto left computer programming, returned to graduate school and then proceeded through medical school. He considers himself fortunate to have had two dramatically different and rewarding careers, and the first career has dutifully provided him with a strong business foundation for his second career.

The Business of Medicine

In some ways, Notaroberto is like thousands of other U.S. physicians, working in a solo practice or a small practice of two or three doctors. But in one major way--his IT training and work experience--he is unlike most other physicians.

In 2004, he decided to search out a new practice management (PM) system that would allow him to outsource CPU load to free up processing space, reduce his total cost of IT ownership and support his desire for off-site data management as part of a disaster prevention plan. After considering several server-based and Web-based systems, he selected NueMD from Nuesoft Technologies in Marietta, Ga. The product's Java-based interface and low cost were two primary factors that influenced his choice.

Moving to an Internet-based system was a critical decision, complete with positives and negatives. "There is no foolproof way to make such a decision," he says. "With a server-based PM system, the practice is locked into proprietary software and even hardware that must be serviced by the supplier. Significant issues, like cost containment and portability, are outside of your control."

The first obligation of a medical practitioner, says Notaroberto, is to take the best care possible of his patients. After that, he acknowledges that the practicalities of also running a medical practice as a business play a role. "Medicine is a business of data acquisition and data management on behalf of patients. You have to buy the best equipment to take care of both your patients and your business, and you have to watch costs without sacrificing any elements of quality patient care."

Notaroberto admits that even ASPs (application service providers) have a downside: They are broadband dependent. He addresses that with contingency-based planning and redundancy, and with two methods of data access. "If one is down with one provider, we have an alternative. In addition, all our data is redundantly backed up," both with Nuesoft and a second service provider in California.

Back in 2004, expandability and portability were among Notaroberto's top systems concerns, as well as trying to rein in expenses. Today, he uses a laptop that travels with him to the hospital or home, or even to an Internet cafe, with which he can access data. His business has expanded substantially, and he finds the system well able to handle the increased demands.

Smile, You're on EyeCam

NueMD gives EyeCare 20/20 the registration, insurance eligibility and verification, scheduling, claims, billing and reconciliation functionalities that a practice would expect from a PM system. But Notaroberto also used the PM system for deliberate process improvement within the practice's workflow, and he achieved results to write home about.

He set the system to monitor patient flow in the office, using a live Web cam and a medically trained auditor, who is also a C.P.A., at a remote location. NueMD, he says, supports an extremely detailed time analysis. "We looked at everything from the moment the patient arrived, through check-in, through being seen by the physician and right through checkout. We wanted to see exactly how long a patient has been at each stage, and what might slow me up or slow up my nurse. Just examining those four points of data--and we examined more than four--we were able to identify exactly where the bottlenecks occurred."

His auditor was already familiar with the NueMD system, so a learning curve wasn't at issue. But Notaroberto says that even an auditor not trained on the system could be brought up to speed in a day or two. As it happened, EyeCare 20/20's audit was only one day long and, "We didn't even need the Web cam. We knew within the first day what needed to change," he says. The practice made the necessary workflow changes and "we saw results within a week." Essentially, a long wait time--one that could stretch to two hours or possibly beyond--was reduced to the 30- to 40-minute range within one week. That allowed Notaroberto to increase his patient flow by 25 percent almost instantly, a dramatic increase for a solo practitioner.

# posted by Medical Information : 2:33 AM