BAI’s digiChart EMR targets clinical specialties

BAI’s digiChart EMR targets clinical specialties

Physician workflow holds key to adoption

Although everyone agrees that electronic medical records are a good idea, the market has suffered from a lack of consensus on their implementation. At issue is their perceived impact on physician workflow, which has proven a formidable barrier to adoption.

Recognizing that each medical specialty has different workflow requirements, BAI Clinical Software, based in Nashville, TN, is taking a modular approach to EMRs. Founded in partnership with Vanderbilt University Medical Center, the firm developed its EMR system, digiChart, after trying to install an off-the-shelf EMR product at Vanderbilt that did not meet the client’s needs.

digiChart was built specifically for allergists and immunologists on a Microsoft platform using Windows NT and SQL Server, rather than as a one-chart-fits-all offering. digiChart uses scanning technology to capture the patient data. BAI takes the forms used in a particular physician practice and maps those data elements into the EMR using checkboxes and optical character recognition.

“There are three reasons why EMRs haven’t been successful,” said Dr. Bill Bates, president and CEO of BAI. “Hardware costs were prohibitive; the computer, keyboard, and mouse set a barrier between doctors and patients; and physicians don’t want to be keyboard literate, because it slows down their workflow. Our mission is to find a way to accomplish the goal of capturing data using a structured format, with no slow-down.”

The system also allows clinicians to make free text annotations that are reviewed for accuracy at a verification station. According to Bates, BAI’s goal is to fit into the physician’s current work process; therefore, the firm chose to work initially with paper forms rather than electronic.

“Data from the checkboxes are 100% accurate,” said Bates. “Now, the scanner only recognized about 30% of my handwriting. So we have a person to verify the annotations at a verification station. Because no specialized medical transcription knowledge is required, this reduces costs significantly.”

Once the patient information is in the digiChart system, the EMR can be viewed on screen, printed, and transmitted via e-mail. digiChart also has DICOM infrastructure, so it can store and forward DICOM-compliant images and can convert images into a JPEG format.

BAI is still designing a security module that will comply with the final HIPAA standards. BAI plans to use smart cards for user authentication. For access control, BAI is evaluating the PICASSO model (Pioneering Caller Authentication for Secure Service Operation), which is based on voice recognition technology. While audit trails are easily implemented, encryption is not as simple as it seems, according to Edwin Miller, vice president of Information Systems.

“We don’t know yet if HIPAA will require that patient names not be included in the same data packet as patient information,” said Miller. “Encrypting the packets themselves is easy, but separating the patient name from the rest of the data is not straightforward. Most security vendors aren’t doing that.”

BAI plans to expand the digiChart offering to other medical specialties, focusing first on obstetrics and gynecology, then on cardiology and ear, nose, and throat. According to Bates, the firm chose ob/gyn as its first new market because of its “retail” aspect.

“We want to enable patients to access a practice online, pick their own appointment time,” Bates said. “Patients will answer questions to go into a database that will be configured specifically for the physician. The EMR really belongs to the patient, but we have to sell it to the physician for the patient.”

Initially built using the client-server model, the firm has Web-enabled digiChart and is looking at offering its software via an ASP model. BAI is also considering strategic partnerships and alliances to complement its products. In addition to digiChart, the firm markets two other Web-based products: doctorsOrders, a Web-based disease management program dealing with chronic conditions; and mediTask, a task management tool that “learns” workflow pathways as it is used.

According to Nelson, the pricing structure for these products is evolving. Using the cost for the MedicaLogic/Medscape EMR as a benchmark, BAI anticipates offering its Web-based EMR initially in the $300 to $500-per-month range.