What Tech Has You Talking?
Send your recommendations of innovative rheumatology technologies, research projects, or can’t-live-without gadgets to [email protected]. We may feature your idea in a future “Tech Talk” column.
A simple fact of human nature played a big part in why Michael Nusbaum, MD, a bariatric surgeon at Obesity Treatment Centers of New Jersey in Livingston, decided to create a medical communications system. People don’t like to hear bad news. And when they hear some, they sometimes stop listening.
“A lot of patients have what I call ‘bad news deafness,’” Dr. Nusbaum says. “That’s kind of a natural response. You hear the word ‘cancer’ and you stop listening to everything the doctor says. The problem is there are a lot of instructions that are continuing to go on and they don’t hear any of it.”
With MedXCom, a platform that weant to market this year, he’s hoping to fix that problem. When a patient calls the physician’s office, they’re connected into the MedXCom system and the doctor’s phone then rings. The physician can listen to a message the patient has just left, then either take the call or have the patient leave a message to be returned later.
The system gives physicians a chance to connect into an electronic medical record, which allows an information sheet on the patient to become immediately available on a smart phone before they take the call. That way, the physician can become familiar with the details, if he or she isn’t already familiar. That can be especially helpful if the on-call doctor isn’t that patient’s main physician.
All of the calls using MedXCom are automatically recorded and accessible on a smart phone, through an app, or on a desktop computer.
The recordings, Dr. Nusbaum says, are meant to protect both parties—the patient can go back and listen to the recordings if the physician makes them available, and the physician has his or her instructions recorded to prevent misunderstandings.
An Informational Safety Net
Dr. Nusbaum knows what can happen when there is no recording of an important medical conversation. A senior partner of his was involved in a medical malpractice suit in which the wife of a patient claimed that he never told her to take the patient to the emergency room.
“He swore that he told her,” Dr. Nusbaum says. “And I have no doubt that he did tell her.” In the courtroom, he says, the woman admitted that his partner told her to go to the E.R. but said he didn’t emphasize how important it was. His partner ended up settling the case. A recording of the call might have stopped the case in its tracks.
“I definitely recognize the fact that there was a need for recording of the conversations, but not only to record it to protect the doctors in a medical malpractice situation, but also to protect the patients, so that the patient can actually go back and listen to the conversation and hear the things that the doctor instructed them to do,” Dr. Nusbaum says.
Physicians also have the ability to order transcripts for each call, or have the system automatically create transcripts for all calls. Users can request a computer-generated version, a version transcribed by a live person, and a version transcribed by several people and scrubbed for complete accuracy.
There is also a patient-to-physician secure messaging service, as well a physician-to-physician messaging service, which has allowed discharges to happen more quickly.
“The rates of stay are decreasing because they’re able to say, ‘I already saw your patient so-and-so in such-and-such room and this is what the plan is and we’re going to be able to get her out tomorrow,’” Dr. Nusbaum says. Without the convenience of the messaging system, “the doctor might not have gotten that information” and the patient might have stayed in the hospital longer.
Patients also have the ability to get reminders on taking medications and receive recommendations based on standard guidelines for preventive care—like reminders to have a colonoscopy or a mammogram.
Flexible Tool for Practices
The system was just completed at the beginning of 2011 and launched to the general public in early 2012.
The cost is $29.95 per month for a group of up to four doctors; $49.95 for a group of five to nine; and $79.95 for a group of 10 or more. The secure messaging service is free, Dr. Nusbaum says.
He says about half of the clients use MedXCom around the clock as their answering service. The system is set up to call certain on-call physicians at certain times, so a patient is always able to reach a physician—or other health professional or office staffer, depending on the nature of the call—or leave a message.
Peter Salas, MD, a plastic surgeon in West Orange, N.J., says he switched about five months ago after talking to the creators of the system about it.
“I wasn’t happy with the answering service that I had anyway,” he says. “They took a long time to answer.” Plus, he wasn’t getting some of his messages, he says.
He was paying about $300 a month for an answering service; now he’s paying $50 a month.
“It eliminates the middle man so I get the messages directly,” he says. “So I can either respond to it immediately if I choose to, or I can just take a message and respond later on. Everything gets recorded so I can go back and review stuff.”
Dr. Salas adds, “The most important thing for me is making sure I get everything.”
So far, the system has worked well—although he hasn’t yet tried the feature that automatically makes the patient information sheet available when they call, or the transcription service.
“There is that time period where [patients] might have to wait for me to listen to the message and pick up the call, but the gratification there is they get to talk to me immediately versus leaving a message and waiting for me to call them back,” Dr. Salas says. “I think patients like it …. They do get somebody right away as opposed to where they might call an answering service and they might be on hold for a long time then leave a message, then wait for me to call them back.” the rheumatologist
Thomas Collins is a freelance medical writer based in Florida.
