This document discusses how medical practice managers can optimize their use of technology through cloud computing solutions. It begins by debunking common myths about high costs and IT expertise being required. Specific examples are provided of how the author implemented cloud-based solutions for electronic medical records, telephone systems, payroll, and other services, saving thousands of dollars annually compared to traditional on-premise systems. The document encourages managers to research affordable cloud alternatives before making new technology purchases.

1. What is your practice’s smallest problem?WHAT IS YOUR BIGGEST PROBLEM? .

2. Outsmarting the Geeks How medical managers can optimize time, money, and tech!

3. Camille A. Williams Administrator, ENT ASSOCIATES OF SOUTH ATLANTA; HEALTH & TECHNOLOGY RESEARCHER & EDITOR; CERTIFIED NEUTRAL/ MEDIATOR, USA

4. What is "Outsmarting a Geek?" Simple phrase for knowing enough NOT to get taken advantage of AND To get your best options on all transactions.

5. PURPOSE OF THIS PRESENTATION Prepare the medical manager to take advantage of technology without high price tags and/or frustration. To provide thorough understanding of technology options for everyday use. To answer questions about new technologies and their value to the medical practice.

6. MY MOTTO CHEAP IS CHIC It doesn't matter if you're a one-doctor shop or 100 physicians strong, there are affordable, scalable solutions for almost any aspect of your practice. Fortune 5 - 500 companies use these solutions to cut their expenses. Why shouldn't you?

7. AREAS OF IMPROVEMENT Personnel Telecommunications Patient Interaction Office Hardware Staff Training Accounting Administrative Tasks Practice Income

8. Myth vs. Truth Common myths regarding technology, medicine, and the digital age

9. Myth #1 Only an IT (Information Technology) professional can work on, maintain, or fix a computer system.

10. Truth #1 Computers, like Virginia Slims (TM), have come a very long way baby! Most computers can be successfully maintained by someone with a two-page manual.

11. Myth #2 The more I pay for the computer or system in question, the better the quality system I'll get.

12. Truth #2 Not necessarily. In technology, the rate of positive change is about 90 days. For example, wait 3 - 6 months after Christmas and the fully-loaded TV or computer you want can be found at a 30-60% discount. Patience, even a little patience, is a virtue.

13. Myth #3 All the salespeople and practice magazines say that without new technology my practice will fall behind the times, so I should buy whatever is on the market.

14. Truth #3 Put down the order form... The truth is that technology is a tool. Matched well to your needs and talents, it's an effective tool. Poorly matched, it's a hassle.

15. Example of Truth #3 Grandma's Computer: A very nice clothes stand. Too much computer!

16. POP QUIZ! What is Cloud Computing?

17. Answer: It's Internet-based computing, where Shared Resources, software, and information are provided to computers On Demand, like electricity.

18. Defogging Cloud Computing You are already using Cloud Computing in your everyday life if you do any of the following: 1. Use a search engine. Google anything lately? 2. Check email online. 3. Buy a website name online. 4. Shop on eBay, Target.com 5. Enjoy a little Farmville or online Poker

19. How can a manager use this?

20. Example #1 Traditional Word Processing: Office buys Microsoft Office for all computers. Each computer has a license, but two are included per disc. Each disc of 2 licenses is $300. 7 computers = 3 licenses needed 3 licenses x $300 = $900

21. Using The Cloud Alternative: Online Document Management & Calendar from Google. Linked to email account, includes word processing, spreadsheets, presentations. Accessible anywhere with internet access. No license, no maintenance. $50 per user per year for Enterprise Solution, otherwise... FREE

22. How is Money Generated if it's Free? The good old-fashioned way: Advertising! Think of Cloud Computing as Free Television: ABC, NBC, CBS

23. Traditional Computers and Networks, by comparison, are Digital Cable.

24. What about Security?

25. Security in Cloud Computing First, you should know....security is a concern whether your information is stored on a disk, in a chart, or on your email account. Passwords matter!

26. The Cloud…Compared with a "Legacy" system Less Equipment to replace Nothing to “walk out of the door” Track access of each user Restrict access for each user Multiple backups in multiple regions of data, information

27. What Camille Did... Briging Cloud Computing into a Small-to-Medium size medical practice

28. Simplicity is the Ultimate Sophistication ~LEONARDO DA VINCI

29. First, I decided to stop purchasing... What if you never bought another computer license...ever again? What if you never paid for another Software Update? Or, better, never waited through another Software Update? =

30. Practice Priorities Budget Electronic Health Record Improve/Increase Services for Patients Communications Security

31. BUDGET Target Big Ticket, Recurring Expenses: Staff, Telephone, Clerical Supplies

32. First Target: Telephone Our average 2008 Telephone & Data bill was $2000 per month, for two offices. $24,000 per year. Downsides: Could not transfer calls between offices, no caller ID, manual forwarding to answering service, no way to track call volume (relevant to the staff expense)

33. Went "into the Cloud" Chose a new Telephone Service Provider After careful research, chose two Enterprise Voice-Over-Internet-Protocol (VOIP) providers to trial. WHAT IS VOIP? Phone service over the internet

34. VOIP on a Budget Auto-Attendant Advanced Voicemail Custom Messages Online System Management Flexible Routing Custom music on hold Detailed call reports Conferencing Caller ID Call Waiting Call Forwarding Find Me/Follow Me Call Transfer Voicemail sound files

35. New Monthly Telephone Bill? Telephone: $300 per month for two offices Data: $400 Total: $700 per month or $8400 per year One-time investment in telephones: $1600 New annual total for service after phone purchase: $8400

36. $24,000 - $8400=$14,000 saved in 2009 on Telephone & Data, more features, more control

37. Thin Clients & Simple Servers 1 – regular PC = $1200 7 Thin Clients for the two offices = $1400 Splurged on new monitors @ $100 apiece = $500 1200+1400+500 =

38. Total Cost: $3100 to update computers in two offices, used by 7-10 people By comparison, we could have spent $8400 + software Savings: $5300

39. Control over each terminal use Control over websites Documents Communication Software License: 1 No more wondering what websites the staff visit. I can look at each user's log of activity and limit access as I see fit. No expensive Firewalls, or software.

40. Why is it important to control use? It’s super easy to download a virus that can – and will – infect every single computer Anyone using email can open an attachment or have one open automatically if the virus is programmed to do so Bad Examples: One employee used to stream sermons from her church to listen to at work. That activity crashed our system with a Trojan Horse virus. I once overheard an employee brag that she still kept tabs on her old office by having all emails sent to her account – first! She was locked out of our system before the ink on that pink slip cooled!

41. Cut the charge by 75% on our PM Software, which we paid for by license = $1500 savings in one year

42. Finally, after a 6 year search... With prices ranging from $50,000 per license To $650 per month + a “$2000 set-up fee”, per physician My practice has converted to EMR...

43. FOR FREE well, okay, I bought the doctor a tablet computer

44. The Beauty of the Cloud No Installation, we just log on from any computer ePrescribe - with the Medicare incentive Fully Functional in Five Minutes Secure Intuitive No Training Expenses (all videos on YouTube!) Oh yeah, and we are eligible for Federal Funds...

45. CRITERIA 1. Affordable - I can give an educated guess to the costs of most EMRs and they are grossly overpriced 2. Easy-to-Use - If it's harder than email, it's a disaster for me and my doc. If I require 40+ hours of training, the product is not EASY or well-planned. 40 hours of training = $6000!!! 3. Web-based - I am not buying and maintaining equipment. 4. Customizable - I'm picky, so is my doctor. Over the years of evaluation we've gotten very specific. Added Bonus: No smarmy salesperson who knows less about EMR technology than I do and just wants to make numbers!

46. Security Secure Bank-level encryption Backups, redundancy, biometrics, disaster recovery Fortune 500 security for the small office Service Level Agreement (SLA) guarantees uptime You maintain ownership of your data Traditional vendors Cannot guarantee security at any level with onsite installations Protocols, uptime/SLA, redundancy, audits (practice’s responsibility)

47. About Practice Fusion EMR Who is Practice Fusion? Founded in 2005 Largest and fastest growing EHR community Over 40,000 users in all 50 states 400% community growth in 2009 Backed by salesforce.com and the original funders of Apple Premier EHR for offices under 20 practitioners

48. EHR Incentives Economic stimulus incentives - $44,000 Practice Fusion guarantees HHS certification Providers can qualify for $44,000+ for using an EHR system Only Practice Fusion enables you to pocket the stimulus funds Learn more about the stimulus plan on PracticeFusion.com “You guys are truly an example of progress and forward thinking for the second decade of the 21st century and web 2.0 in medicine. Keep up the great work!“ – Dr. Pina

49. SUNSHINE AMIDST THE CLOUDS The HHS vision for health IT can’t be achieved with client-server installation. The purpose of Washington’s $19 billion investment is to make health data portable and interoperable. Immunization registries, Personal Health Record systems, research for public health, emergency-access health data, patient driven mobile health devices – all this is powered by web-based EHR platforms where health data is no longer locked in silos.

50. Other Cloud Uses "Information Workers" *Hired an RN in Indiana to get surgery pre-authorizations *Hired team in another country for live phone reception *Regularly hire online for contract review &document creation (at fraction of the cost)

51. FINANCIAL MANAGEMENT Create practice budgets Analyze debt/ plan repay ROI of Purchases Break-Even Analysis Revenue Projections Calculating Expenses Weekly Bookkeeping Increasing practice income

52. Payroll – Save 60% or More Old Payroll service charges: *Minimum $150 per month Additional charges for filings Additional charges for bonuses Annual charge: $1800 New payroll company? $55.00 a month, no extra fees Annual Charge: $660 Added bonus: web-based time clock to calculate payroll Savings: Over $1100 per year, with more options & control

53. Resources for Research & Change EHRbloggers.com - EMR VOIPReview.com - Telephone Dinkytown.com - Finance Paycyle.com - Payroll Weebly.com – Fee Websites Lifehacker.com –Useful ideas eLance.com - Freelancers

54. THANK YOU! I'll take questions if there are any...