The Pros and Cons of Health Information Technology Print E-mail
Written by Todd Demel,MBA   
Friday, 20 August 2010 10:16

Health information technology(HIT) comprises systems such as the electronic medical record (EMR),computerized physician order-entry (CPOE), and decision support systems that integrate and improve access to health and patient-related data. The adoption of such technologies is a complex process for a number of reasons. Perhaps the primary roadblock to or disincentive for adoption is that it is one of the most expensive capital investments for any healthcare organization. Physician perception varies widely as to whether or not implementing HIT is desirable,affordable, or even feasible.  However, the case is strong for adoption of health information technology as it offers many clinical and economic advantages.


Coordination of Care - HIT enables a framework for the coordination of care thereby encouraging patient-physician partnerships. In this environment, a team of practitioners works together, moving beyond the paradigm of mere episodic visits.

Decision Support -Physicians currently face a myriad of clinical challenges, including many thousands of possible diagnoses that can be treated by various procedures and different drugs, all of which present potential adverse side effects. Such systems serve to integrate and improve access to health and patient-related data.

Access to Information - HIT enables users to retrieve and store vital medical and patient information which allows patients to be notified of recalls, side effects, and interactions associated with medications they may be using.

Reduction of Costs - Electronic Medical Records can reduce filing and transcription costs. By minimizing the need for paper clinical records, practices can reduce the support staff traditionally needed to perform filing and transcription duties. The potential savings here can be substantial.

Decreased Duplication - The implementation of information technology has been shown to significantly prevent the duplication of imaging and laboratory tests.

Improved Coding - There is potential to substantially impact coding accuracy and revenue capture.

Fears & Concerns:

Despite the many benefits of healthcare information technology, many physicians are hesitant to switch to an electronic system. While insufficient financial resources may be the biggest impediment to implementation, negative perception is another contributing factor. Among the concerns expressed by physicians is that, if it is poorly designed, a computerized physician-order entry system could increase medication errors. There is also a fear that, due to the capacity to copy/paste parts of the electronic record it may be too easy to avoid taking a complete patient medical history. And this in turn could lead to inaccurate assumptions about a patient's condition. Since EMR utilizes templates, physicians may also feel restricted when speaking with patients which could impact the accuracy of diagnoses.

Another negative perception related to the implementation of HIT is that, while providers will inevitably bear disruptions to their established system, payers and patients will gain most of the benefits. So, while physicians and health systems must incur the cost and associated learning curve, insurers get to enjoy the substantial cost savings resulting from automated record handling and having to pay for fewer unnecessary tests.

Equally disconcerting to physicians is the fact that many HIT implementation programs have either been fraught with complications, or failed altogether. Inadequate project management is likely the cause of such breakdowns with many projects running late, or over budget. In some cases, the technology may lack features it was expected to have. The culprits often contributing to these problems include poor planning, miscommunication, mismanagement, overspending, as well as rejection by users.

Achieving Successful Implementation: 

Planning - It is critical that during the planning stage physicians are engaged and participate in the process of design and widespread use of HIT. Physician input is critical to the project's success, and the design of the system should incorporate physician input each step of the way. The practice should designate a specific physician champion, an individual with good leadership skills, as they will be able to achieve buy-in from other physicians and staff.

Resources - Allocation of sufficient human and financial resources must be committed to the effort. Both physicians and clinical staff members should be part of this group.

Project Manager - This individual should initiate and assist in the selection of a system vendor.

Equipment - Determine whether the work environment can accommodate a wireless set-up. Investigate the type of hardware that will be compatible with the vendor's software and serve as the best fit for the providers. Consider logistics with respect to workflow and space capacity in the office. Other equipment such as fax machines, scanners, and printers will need to interface with the system. So, all of these details need to be considered with respect to compatibility and design. 

Framework - If the change is to be sustainable, there should be a logical framework established. For example, this could entail having teams first perform the groundwork, and then embed the change.

The team needs to create a sense of urgency for change by stressing the advantages of the technology. The vision should be clear and uplifting and the group guiding and championing the process should consist of respected individuals who can align resources to achieve the stated objectives. The advantages of an electronic system should be emphasized to everyone, highlighting some of the following benefits:

     Clinical decision support tools - available at the point of care to increase accuracy of order sets.

     Customization - enabling patient-centered care, tailored to individual needs, where necessary.

     Efficiency - greatly improved transmission times in sending orders to receiving departments.

     Clinical Database - enabling staff to continually review and analyze orders and outcomes due to the quality and depth of data collected on an ongoing basis.

The message must be communicated ongoing, through multiple channels such as medical staff and other department meetings so that all employees become aware of the efforts and objectives. Removing obstacles wherever possible will empower people and facilitate the use of the system. Addressing concerns and problems as they arise will also go a long way towards expediting implementation. And creating short-term wins along the way can provide momentum. For example, displaying a quality dashboard that reflects early stage improvement in patients, or one that provides a snapshot of outcome data along with benchmarks will demonstrate to physicians the actual impact the technology can have.  Momentum must be maintained throughout the change process as a new culture is gradually born. This can be achieved by getting physicians involved as much as possible during all stages of the implementation process.

Strategies for Success:

Selecting the Right System- Poor choices can lead to numerous problems including disruption of patient care as well as physician dissatisfaction. The purchase decision should be aligned with the clinical strategic vision and consider the system's feature set, ease of use, as well as the satisfaction rate of other similarly-situated users. One of the best ways to evaluate an installed HIT system is by visiting the sites of clients currently using the vendor's product. In this way, the functionality of the system can be observed in various patient care areas during peak times. 

Forging a Partnership - It is important to establish a strong working relationship with the system vendor you ultimately choose to do business with. Because a vendor relationship extends well beyond the adoption and implementation phase, consideration should be given to the degree of a vendor's trustworthiness. Support will certainly be required after the initial purchase phase and expectations should meet with the promises that were originally made by the vendor at the time of sale. Issues will inevitably arise, and a positive vendor relationship can ensure that problems are resolved quickly and that needed support is always available.

Pricing - During negotiations, products, services, and support should be scrutinized with the vendor. The purchase price of the system must include ongoing maintenance, support, and upgrades. 

Physician Preparation - After submitting a proposal, vendors can be invited to perform a demonstration for the medical staff. Identify workflows and clinical processes that may be streamlined, and schedule meetings with physicians so that strategies can be discussed. Since trained physician users can be invaluable champions of the HIT effort, provide mandatory training sessions for physicians and their assistants.

Projections - Implementation will impact patient volume until all functions of the practice have adapted to the accompanying changes. Therefore, physicians should be prepared for an initial decrease in productivity. Since this will necessarily impact revenue, appropriate budgetary decisions must be made. Cash flow projections for practice revenue should be run based on decreases ranging from 25% to (worst case scenario) 40% on a monthly basis for the first 90 days. 

Going Live - Lighten the schedule with respect to elective clinical procedures for the first month after the go-live date to accommodate initial system inefficiencies. Once the system is in place, offer periodic refresher courses. Track metrics with respect to quality, billing accuracy, and user satisfaction. Then display this data on a dashboard and distribute for monthly review by physicians and management staff. 

While implementation of new technology throughout an organization is inherently disruptive as it inevitably places additional burdens and workflow challenges on staff, strategies such as those described above can be employed to make the transition successful. Commitment across the team of physicians and staff will contribute greatly to a smooth transition as well as a positive return on investment. 

About the author:  Mr. Demel oversees Business Development at MF Healthcare Solutions and also serves as Membership Chair-Elect for the South Florida Healthcare Executive Forum.  He has over 20 years experience in healthcare operations, practice management, and marketing, with emphasis placed on outstanding client service. Possessing both operational and financial backgrounds, the MF Healthcare Solutions management team has vast experience in a range of healthcare industry settings. The combined expertise enables the firm to offer specialized and effective physician practice management services. For more information, please visit: or contact Todd Demel at (954) 475-3199. 

Last Updated on Sunday, 29 August 2010 12:36
Case Study: Disability Claims and Disputes Print E-mail
Written by Jeffrey Herschler   
Saturday, 31 July 2010 15:33

medical-examThe aging of America is sure to result in an increase in disability claims. Debilitating conditions tend to manifest themselves during the aging process. Nowhere is the trend more imminent than in Florida’s healthcare workforce where the average physician is in his or her early fifties. The typical administrator is in his or her mid forties. Meanwhile the insurance industry is grappling with an investment portfolio hammered by the Great Recession and some poor underwriting criteria in the past that resulted in under pricing. Therefore, another trend to beware of is an increase in disputes as insurers attempt to mitigate the influx by denying claims. Below are two case studies that illustrate the challenges faced by disability policyholders who claim benefit.

Disability Case Study #1: 


Scheduled exam with non-doctor

This firm represented a registered nurse who applied for and received disability income benefits based on a total disability due to cervical and lumbar disk herniations. During the course of the claim, and while the insured was being paid monthly disability income benefits, the carrier scheduled a functional capacity evaluation ("FCE"), to be conducted by a therapist. The key to success in this case was the firm's careful review of the disability income insurance policy and experience in handling such disputes. The policy provided that the insurance company had the right to require the insured to undergo a medical examination conducted by a physician of its choice. There was no provision in the disability policy providing the insurance company the right to conduct a FCE or such an evaluation by a non-medical doctor.

On behalf of the client, the firm filed a lawsuit in Federal court seeking a declaratory judgment, injunction and recovery of attorneys' fees and costs. The declaratory action sought the judge's decision on the insurance carrier’s right to require the client to undergo a FCE by a non-doctor in order to continue to receive monthly disability income benefits. The injunction sought to prevent the insurance company from requiring the client to undergo a FCE in order to continue to receive monthly disability income benefits. When the insurance company was served with the lawsuit, it cancelled its scheduled FCE. Thereafter, the insurance company requested that the law firm dismiss the lawsuit. The firm advised the insurance company that the case would be dismissed if the insurer agreed in writing that it did not have the right to pursue a FCE under the terms of the policy, and would never seek to schedule a FCE. The insurance company would not agree to same. Thus, this case is pending a decision by the court.

Disability Case Study#2:


Client's Rights under Florida Law -Videotaping IME

The firm represented an orthopedic surgeon who owned a disability insurance policy insuring him if he became unable to perform the material duties of his own occupation. The surgeon developed carpal tunnel syndrome and was unable to do what he previously had spent his days doing, which involved spending approximately 90% of his time performing surgery. He filed a claim for disability income benefits. The insurance carrier accepted the claim. During the time the insurance company was paying the surgeon benefits, the insurance company scheduled a independent medical evaluation ("IME") for the surgeon, which is in fact an insurance exam with rarely any independence. The insurance company advised the surgeon that he was required under the terms of the policy to attend the evaluation alone. The insurance company also advised the insured that it could terminate his claim if he failed to cooperate. The surgeon contacted the law firm to handle this matter.

The key to the law firm's success was a careful review and understanding of the terms of the policy and Florida law. While the disability policy contained a provision permitting the insurance company the right to require the insured to attend a medical evaluation performed by a doctor of its choice, it did not provide that the insured must attend the evaluation alone or that benefits could be terminated based on the insured's demand to have a third party present at a IME, including a videographer. The law firm advised the carrier of client's willingness to cooperate and attend an IME, as long as it could be videotaped by a professional videographer. The law firm received a copy of the doctor's qualifications and proof the doctor had malpractice insurance.

The insurance company argued that there was no right to have the IME videotaped. The firm responded by providing Florida case law addressing the right of workers' compensation and personal injury claimants to have a third party, be it an attorney or videographer, present at a medical evaluation, considering the adversarial nature of the IME. The law firm went further and advised that it would be filing a declaratory action so that a judge could determine whether under the terms of the policy the carrier had a right to refuse the videotaping of an IME and would seek costs for going through the process. The carrier finally agreed to allow the videotaping of an IME prior to institution of a lawsuit.


Thanks to the Wagar  Law Firm for contributing the case studies.  Contact or visit


Last Updated on Sunday, 22 August 2010 15:00
FTC Announces New Guides on Endorsements and Testimonials in Advertising Print E-mail
Written by Jeffrey Segal, MD JD & Michael J. Sacopulos JD   
Monday, 12 July 2010 10:20

The Federal Trade Commission (FTC) on October 5, 2009 released "Guides Concerning the Use of Endorsements and Testimonials in Advertising."  This is the first update the FTC has made on this topic in approximately thirty years.  Much of the new Guides address social media.  With an increased number of healthcare practices and hospitals embracing an Internet presence, the FTC Guides Concerning the Use of Endorsement and Testimonials in Advertising may have broader ramifications in the healthcare industry than might be suspected. 

Medical Justice's General Counsel, Michael Sacopulos, sat down with FTC Assistant Director of Bureau of Consumer Protection, Rich Cleland, to discuss the impact of the new Guides on the medical community.  Below follows a portion of the conversation between Michael Sacopulos (Medical Justice-MJ) and Rich Cleland (Federal Trade Commission-FTC).

MJ:                   The FTC recently published final Guides governing the use of endorsements and testimonials in advertisements.  How, if at all, do you foresee these changes will impact medical providers?


Medical providers in terms of their promotions are subject to the FTC Act.  Therefore, all of the Guidelines could theoretically apply to promotions advanced by medical providers.

MJ:                   The Guides used to allow for a disclaimer of "results not typical."  The revised Guides no longer contain this safe harbor.  How should health care providers that perform aesthetic procedures, and advertise via testimonials and photographic results adjust to the revised Guides? 

FTC:                 One of the things that are going to be different has to do with the impression left from the ad regarding the typical experience or results.  Not only is it advisable to indicate that results may vary, I would go beyond that and try to identify factors that may account for the variability of results.  Ultimately, it all depends on the wording and layout of the advertisement.   

MJ:                   Just to be clear, does the Commission consider a photograph an endorsement? 

FTC:                 Depending on its use, a photograph could be well be considered an endorsement, even if it is not accompanied by text. 

MJ:                   There are a variety of Internet physicians "rating" sites.  Some provide critiques of cross-industry such as Angie's List and, where as others are specific to the medical field such as and  Because of the anonymity of those who post on these sites, there is a general fear that the sites are being manipulated either positively or negatively.  Is this generally a concern for the FTC?  If so, can you generally describe the FTC's approach to this situation? 

FTC:                 There are two issues here.  If a physician goes onto a rating site and posts a glowing review of his or her services and does not disclose his or her identity that would be a violation of the FTC Act.

Secondly, negative comments about an individual would not be considered an "endorsement."  However, should the negative comments be posted by an ex-spouse or former employee posing a patient, this would be considered deceptive.  Deceptive comments in this forum would also be considered a violation of the FTC Act even though this is not specifically addressed in the recent Guides.

MJ:                   Does the FTC have legal authority to determine the identity of anonymous bloggers? 

FTC:                 If the anonymous blogger in question is relevant to an ongoing investigation of the FTC, the FTC has the legal authority to determine the identity of the blogger.

MJ:                   The revised Guides provide additional information on what the Commission considers a "material connection."  More specifically, a "material connection" is a relationship between an advertiser and endorser which a third party consumer would not expect.  If a physician reduces his or her standard fee for a procedure for a specific patient, would that fee reduction be considered a "material connection" between the physician that patient? 

FTC:                 The answer is yes.  However, it may be helpful for me to give you a factual situation where I don't think a disclosure would be required. Let's say I went into a doctor's office and I don't have insurance, the physician goes ahead and treats me and decides that since I don't have insurance, the physician will cut the [fee in] half.  I'm so elated that I go on Craig's List and post a comment on how wonderful the doctor is.  This is not the kind of endorsement that would be covered under the Guides. If, on the other hand, the physician tells me that he will take $500.00 off of the charges if I will appear in an advertisement for his practice, this is clearly an endorsement that would be covered under the Guides.   I am getting something in exchange for the price reduction.

MJ:                   Are there any other areas of concern for the FTC when dealing with individual medical practitioners?  If so, please share those.

FTC:                 I don't think that there are any specific areas of concern for the FTC at the moment.  However, the issue of 'before and after' pictures on cosmetic surgery may become of interest.  The idea of manipulating things or doing something at the core would be prohibited by Section 5 of the Guides.  For example, digital alteration of before and after photographs would be a violation of the FTC Act.

Given the recent revisions in endorsements and testimonials concerning advertisements, medical providers would be well advised to review their websites and all advertising to verify compliance.  Any endorsements by individuals who have received compensation now require a disclosure.  Further, before and after photographs should be accompanied with a disclaimer noting that results vary from patient to patient and should list several factors accounting for variability of results. Finally, if a medical provider believes that he / she is a victim of malicious and false online postings, the FTC may provide assistance.  Should you have additional questions and concerns about the new FTC Guides, you should contact legal counsel.

About the Authors

Jeffrey Segal is a board-certified neurosurgeon who was educated at the University of Texas and the Baylor College of Medicine, earning  Phi Beta Kappa and AOA Medical Honor Society recognition. Dr. Segal is the founder and CEO of Medical Justice.

Michael J. Sacopulos is a partner with Sacopulos, Johnson & Sacopulos of Terre Haute, Indiana.His area of practice concentrates upon healthcare litigation including medical malpractice defense and third party payor issues.   He is General Counsel of Medical Justice Services, Inc.


Click here for information on Medical Justice. 

Contact via email or call 877.MED.JUST (877.633.5878). 

Last Updated on Monday, 12 July 2010 10:46
Med Mal Q & A Print E-mail
Written by Matt Gracey   
Monday, 05 July 2010 16:43

by Matt Gracey  


When choosing a malpractice insurance company, how can I tell which one is going to vigorously defend me?


Defending claims is really where "the rubber meets the road" in malpractice insurance!  Doctors and their administrators often get hung up in looking just at premium quotes, marketing slogans, brokers' service or personalities, or insurance-policy provisions that they might or might not like.  The real reason one purchases malpractice insurance is to be assured of a strong and affordable defense if a lawsuit is threatened or filed against your practice.  Unfortunately, figuring out each insurer's true claims-defense track record has been tricky at best.  The good news is that in recent years, the Florida Office of Insurance Regulation (OIR) has been gathering more and more data on claims defense and now has enough data to make for a credible examination and analysis. 

In looking at claims-defense records, the most useful measurement index is the one gathered on the percentage of cases each insurer has closed without any indemnity payment to the plaintiffs.  A higher percentage indicates a stronger claims-defense philosophy. The industry average in 2008 was just under 50% of filed cases closed without any payment to the plaintiff.  One popular insurer's numbers have fallen rather dramatically, from 90% of their cases closed with no indemnity payment to only 37% of them in the three-year span from 2006 through 2008, despite their marketing folks talking about their strong defense. This example demonstrates why doctors and their administrators need to "look behind the curtain" at the independent OIR data to analyze what kind of claims-defense they are really buying. 

A few notes are important, though.  Some insurers' marketing will show the percentage of their cases closed with no indemnity payment.  However, some of that marketing will skew that percentage by including closed "incident reports" as well as actual cases filed, to make their defense data look better.  Also, some newer or less-popular insurers have so few closed claims that their percentage closed is almost meaningless.  The top insurer in Florida, FPIC, handles so many cases against their large number of Florida insureds that trying to compare their above-average percentage with another insurer handling a fraction of their numbers can be a bit distorting.  Experience does count in Florida courtrooms though, and you can see from the OIR reports how many more cases an insurer like FPIC handles than their counterparts. The OIR data also show the average defense costs spent by each insurer, which is another indication of an insurer's defense philosophy.         

If you would like a copy of the most recent OIR report or to discuss your particular insurer's record, do not hesitate to contact us.  We are independent malpractice insurance experts and will help you through this maze and look out for you.  

Contact the author

By the Numbers: Active Licensees Print E-mail
Written by Jeffrey Herschler   
Monday, 05 July 2010 16:30


Medical Doctors                          # of Active  Licensees 

Alachua                                                      1635

Brevard                                                      1201

Broward                                                     4696

Collier                                                          802

Dade                                                          7229

Duval                                                         2830 

Escambia                                                   848 

Hillsborough                                           3695

Lee                                                             1250

Liberty                                                        1 

Orange                                                     2956

Palm Beach                                             3789

Pinellas                                                    2724

Polk                                                           948

Sarasota                                                  1106

Seminole                                                   791

Volusia                                                      970

                         SOURCE: FL DOH 


Last Updated on Monday, 04 April 2011 06:12
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