Jan 29, 2021 | Digital Pathology, Uncategorized
Running a promising dermatology clinic means continuously seeking ways to enhance patient care quality and maximize staff efficiency. For proof, consider that over 40 percent of practices claim to have implemented EMR systems to help them grow.
While implementing an EMR system for dermatologists has many advantages, there are still some disadvantages to consider. This article will look at the pros and cons of electronic medical record systems for dermatologists, including reducing paper, image management, billing, lab interaction, and EMR limitations to ensure you have the facts when considering ways to maintain quality diagnosis and patient care.
Reducing Paper
One main advantage to an EMR is the ability to access your notes and patient information anywhere. In an increasingly digital world, we are often communicating with patients while out of the office. Still, 25 percent of dermatologists continue to use traditional paper systems to support their operations.
Here are some of the standard paper shortcomings and the ways an EMR system solves them:
- Repetitive tasks: Completing the same functions repeatedly takes time and energy away from vital patient interaction. In addition to autopopulating fields, an EMR sends data electronically, so it doesn’t have to be re-entered.
- Errors: Entering and re-entering data into the LIS introduces the possibility of human error. Entering data one time using an EMR removes the chance of making mistakes on repeat entries.
- Access: Pulling a patient’s paper file can only be done in the office, requiring time and physical space to store the physical records. Using electronic medical records means patient information is stored securely in the Cloud, which providers can instantly access from anywhere with a Wi-Fi connection.
Unlike paper, EMR systems make it increasingly advantageous for dermatologists and their staff to do things more efficiently and conveniently. It is important to ensure staff is adequately trained on a new system and receives regular review sessions to maintain a good standard of EMR charting, as updates occur several times per year.
Managing Images
Patient images in dermatology are valuable, as much of the specialty relies on visual recognition. It is also important when tracking the correct site of a biopsy, especially for referring to other providers like Mohs surgeons.
Digital images are easy to capture, but often cumbersome to organize. If not using an EMR, these will have to be organized in folders with patient name and date and kept in a secure digital environment. Many EMRs resolve this arduous process by allowing you to take photos within the patient chart and automatically assigns the images to the correct biopsy location. These images can be accessed immediately, making it easier for dermatologists to share them with partners and patients or review them on the next visit. Also, being able to review them in the context of your visit with relevant labs and other notes helps in diagnosis, especially of difficult cases.
Reliable Billing
While necessary, billing is not the favorite activity of most providers. However, billing takes time and diligence to communicate with insurance companies and resubmit claims when appropriate. With that in mind, another benefit of electronic medical records is the autobilling feature.
Many EMRs will issue invoices based on coding applications. In addition, some EMR systems claim up to 98 percent first-pass claim acceptance, which means you and your staff can spend time focusing on patient care instead of going back and forth with insurance companies.
Also, EMRs automatically track any changes to Medicare’s Merit-Based Incentive Payment System (MIPS), ensuring your practice receives accurate reimbursement for qualifying services. This eliminates manual tracking and helps you to maintain focus on patient care.
Lab Interaction
Communication with your dermatopathology lab partner is vital to ensure the highest quality of diagnosis for your patients. Full-service dermatopathology labs like PathologyWatch will integrate an EMR interface, which allows them to access the data and fields entered into your EMR system.
Equally important, an EMR interface grants you instant lab results and images sent directly to your device. The EMR also helps you send e-faxes to providers or drop notes directly to the patient’s record, instead of requiring your staff to print out, fax, scan, and wait for a confirmation.
EMR Limitations
While EMR systems embed many time-saving and workflow advantages, they also contain quirks and constraints that users learn to navigate. For instance, 82 percent of physicians indicate it takes too long to enter data that isn’t directly related to patient care.
The EMR could also make it difficult to communicate outside of the prescribed default descriptions. Thus, if you indicate eczema when you’re trying to describe a rash, it may take you longer to type in a custom description than selecting the available options. To make the system work right, you have to be willing to customize your process with templates, adding quick text or macros when possible to aid in customizing each note, and take time to delete unused or irrelevant items within your templates.
Sometimes, adding digital elements can create slow-downs if the interface is down or you experience an error after an update, for instance. This can be challenging if you can’t print out a requisition from your EMR or can’t access patient records while you are seeing patients in the clinic.
In the end, the benefits of implementing an EMR into your dermatology practice often outweigh the disadvantages. By understanding how EMR systems can reduce your reliance on paper, manage images, increase billing efficiency, and boost lab communication, your clinic can make a qualified decision that can help you continue to provide quality care for your patients.
Jan 21, 2021 | Digital Pathology
Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.
In order to diagnose pathologic skin conditions, it’s important to first be able to recognize what constitutes normal skin and variants. In this Digital Dermatopathology Digest episode, Rajni Mandal, MD, uses a digital pathology image viewer to offer a quick summary of key characteristics in normal skin. Here are some video highlights.
Skin Anatomy
The body’s largest organ takes on a variety of appearances depending on the anatomic location. The two outermost layers—the epidermis and the dermis—work closely together. The epidermis, or outer layer, typically has four or five distinct layers of cells but lacks blood vessels or nerve endings.
The inner layer, or the dermis, consists of pink collagen fibers, which are connective tissue that supports, nourishes, and strengthens the epidermis. Also contained within the dermis are key structures such as nerve endings, blood vessels, lymph glands, hair follicles, and sweat glands.
“The dermis can vary in thickness based on location,” says Mandal. Skin of the back and trunk shows more compact collagen fibers and a thicker dermis compared to facial skin. Acral skin shows compact hyperkeratosis of the stratum corneum. Solar elastosis, seen in areas of sun damage, has a gray-purple hazy color and is a collection of excess elastic fibers.
Distinguishing Features of Adnexal Structures
Sebaceous glands have foamy cytoplasm and often attach directly to the hair follicle.
Deeper in the dermis, you can find eccrine sweat glands, which occur over most of your body and open directly onto the surface of your skin. “Eccrine ducts have a two-layer epithelium versus the eccrine glands, which have a single layer epithelium,” explains Mandal. Adipocytes are also found admixed around the glands.
By contrast, apocrine sweat glands are found in the axilla, nipple, ear canal, eyelid, scalp, and genital areas. Very round nuclei, eosinophilic cytoplasm, and eosinophilic secretions within the lumen are clues to apocrine glands.
If you enjoyed this summary of identifying normal skin and variants, or if you are preparing for boards and want to test your dermatopathology skills, check out this and other Digital Dermatopathology Digest instructional videos here.
Jan 11, 2021 | Digital Pathology, Pathology Business
Despite the benefits touted by telemedicine enthusiasts, widespread adoption of this technology has lagged in the healthcare industry. However, with the onset of COVID-19, a new era of telemedicine has begun. Almost overnight, telemedicine became more accepted by regulators, providers, insurance companies, and patients. The combination of improved video technology, patient demand, and provider acceptance has eased restrictions and pushed telemedicine to the forefront in the medical industry.
In addition, dermatopathology is following this trend. Regulations for the remote use of pathology have changed in light of COVID-19, making it possible for pathologists to work remotely and support the use of digital pathology technology for the duration of the pandemic.
With the universal adoption of video conferencing, 20 percent of all medical visits are happening via telemedicine. Here are a few reasons to consider teledermatology:
Convenience
Recent surveys show that a common reason over one-third of patients may prefer telemedicine visits is saving time by avoiding the commute to a provider’s office. For instance, telemedicine can reduce the amount of time away from work or the cost and headaches of arranging childcare. Patients can be productive while waiting for the video conference instead of spending time in the waiting room. Even older patients who might have struggled with technology adoption in the past are more likely to embrace telemedicine options to avoid the increased COVID complications and mortality associated with this at-risk population.
Accessibility
Dermatologists can now use traditional billing codes for teledermatology visits. Teledermatology is accessible even when providers or patients may be out sick but are not debilitated. Many people who test positive for COVID are asymptomatic and would still like to keep their appointments if possible. This helps control the inevitable cancellations required for patients with cold symptoms and need to rule out COVID or flu infection before presenting in your office.
Because of increased access provided by digital dermatopathology, companies like PathologyWatch can employ a national network of dermatopathology experts. Many areas do not have access to dermatopathologists and often rely on expensive locum tenens to provide specialty or overflow care. Also, it can take several weeks to get a second opinion on a case. With a digital workflow, digital slides can be more quickly accessed for consensus diagnosis or consultation.
Teledermatology also provides people living in rural areas or mobility challenges with easy access to medical care using synchronous live video-conferencing. The CDC indicates that telemedicine “can help reduce barriers to care for people who live far away from specialists or who have transportation or mobility issues.” As one dermatologist described, “Our specialty is a visual field, and there are many skin conditions which are diagnosable from looks alone.” Dermatology lends itself well to photographic consultations by primary care providers to dermatologists.
Safety
During the COVID pandemic, the CDC established guidelines to keep healthcare workers and vulnerable patients safe during face-to-face visits. Despite these precautions, healthcare workers are still seven times more likely to develop severe COVID-19 infection than individuals performing nonessential jobs.
Teledermatology encourages a workflow that keeps providers and their staff safe from contracting diseases from patients or other staff members. Also, video conferencing can allow for the outsourcing of specific tasks, such as a scribe. This can help dermatology clinics by having a safe pool of healthcare workers that don’t have a higher risk of developing COVID-19.
Patient Satisfaction
Up to 48 percent of people prefer providers who offer telemedicine visits. A consumer survey revealed that 75 percent of patients who participated in virtual care were very or completely satisfied with the experience.
Meanwhile, telemedicine can level the socioeconomic playing field. Access Derm is an AAD-supported teledermatology program where volunteer dermatologists can help underserved populations who don’t have access to a dermatologist. It helps provide critical preventive care and second opinions, improving the quality of life and reducing the expense of future treatments by diagnosing skin cancer at earlier stages, for example.
When to Consider Teledermatology
Consider teledermatology options for follow-up visits that focus primarily on counseling rather than diagnosis. With these types of patients, rapport has already been established through in-person visits, and with straightforward diagnoses—like acne, atopic dermatitis, and psoriasis—much of the return visit focuses on review of lab work, medication counseling, and treatment changes if patients are not responding to first-line therapies. In particular, iPLEDGE patients or their caregivers, who are required to have monthly visits for the duration of therapy, may save significant time through a teledermatology visit.
While not all visits are possible through video conferencing, making healthcare convenient can encourage more people to seek regular consultations and take better care of themselves.
Jan 5, 2021 | Pathology Business
You’ve done it. You’ve decided to take the plunge and open your own dermatology practice. Congratulations! But take care: With about 20 percent of new small businesses failing in the first year, it’s key to learn from those who have traveled the road to health services self-employment before you. So before you shop for locations and window treatments, here are five strategic tips to ensure your open-for-business experience is healthy and successful.
Secure your capital.
It’s true: For a new business to succeed, it really does take money to make money. Experts estimate that almost 30 percent of new businesses fail because they run out of cash. In fact, results collected by Investopedia show that two of the four most common reasons why small businesses fail involve cash-flow problems—mainly insufficient budgeting and a lack of sufficient capital.
For Daniel Lambert, CEO of PathologyWatch, exploring various forms of capital was pivotal to startup success. “Look at raising from different asset classes: private equity, growth equity, sovereign wealth funds, PE firms, family offices and cash-rich investors. There are many sources of capital that are often overlooked,” he advises.
Once you’ve formalized your vision and bolstered it with a satisfactory cash flow, it’s essential to hire key players who share your vision and offer expertise in fundamental skills.
Hire people with office management, business, and legal expertise.
You may be an expert at differentiating herpes zoster from acne vulgaris, but do you know the latest HIPAA compliance requirements or how to handle payroll tax? Your staff will need both clinical and nonclinical support, so one of your first steps should be hiring those with hands-on management, legal structure, and compliance experience.
“Choosing the right legal structure for your medical practice is one of the most important business decisions you’ll make,” says Jack Wolstenholm, head of content marketing at LeverageRx. “Deciding whether to establish a sole proprietorship or a more complex legal structure must be thought through wisely. It requires calculating both the costs and benefits to your practice, and factoring in your risk tolerance to liability.”
Staying ahead of the game in one of the most highly regulated industries could mean the difference between staying open or becoming a statistic.
Establish your specialized services.
What is your specialty? For instance, if you’re setting up a practice in an area with a year-round sunny climate, specializing in skin-cancer treatment could be your focus. If you are unsure, check out practices in the area. Remember that while you are providing healthcare, you are also a small business owner. That means keeping an eye on your competitors. To narrow down prospective areas, call some practices to check on waiting times for an appointment for new patients. If the wait time is longer than two weeks, there’s plenty of room for another doctor.
“Public demographic information can tell you about future growth in different communities,” say experts at The Dermatologist. “If you expect to attract patients from many different communities, look at traffic flow to make sure your practice is easily accessible.”
Your expertise will help build your patient base, but it’s the mindset of a small business owner that will help keep your doors open for business.
Start by investing only in the essential equipment and space.
With this new cash flow, it’s tempting to overspend during the initial stages of business development. Before you schedule the interior decorator, look at your financial overhead with a long-term perspective. This endeavor is going to put your ability to maximize cash flow to the ultimate test.
One area where you can minimize overhead expenses is usable physical space. Experts recommend starting small and leaving room for expansion. For example, when Jerome Obed, DO, a board-certified dermatologist who runs Broward Dermatology and Cosmetic Specialists in Fort Lauderdale, Florida, opened his new practice, he only prepared two out of his four exam rooms. When his patient numbers increased, he furnished the remaining two exam rooms in his office.
The process of gradually building up at the same rate of acquiring new patients applies to investing in equipment as well. When you’ve determined your specialty, those are the pieces that should be purchased first. To control startup costs, we’ll discuss later the options of outsourcing certain functions to free up funds to purchase essential equipment.
Along with medical equipment, your IT system is an essential part of your office operation—and one of the most expensive. “You’ll need a practice management system for demographic information, scheduling, and billing, and an electronic health record (EHR) system for patient information,” say the staff at The Dermatologist.
Consider outsourcing functions.
Using a third-party service for billing or payroll tasks is a common practice for medical offices of all sizes. Services like PathologyWatch can manage both the business and technology aspects of digital pathology technology. That means your startup can offer all of the services you need to grow your new practice without having to invest in your own laboratory equipment and lab staff.
You may not know what lies ahead when you open your own dermatology practice. But by talking with people who share in your journey for a private dermatology practice and following these five proven tips, you can learn ways to minimize risk while maximizing opportunities for growth.
Dec 30, 2020 | Digital Pathology
Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.
In this episode of Digital Dermatopathology Digest, Rajni Mandal, MD, a dermatopathologist at PathologyWatch, discusses the most common dermatological malignancy—basal cell carcinoma (BCC)—including how common it is, its warning signs, and characteristics of its various forms.
How Common Is BCC?
Prolonged exposure to UV sunlight or indoor tanning contributes to this and other forms of skin cancer, which triggers mutations in p53, PTCH (sonic hedgehog pathway), and SMO gene. Research shows that four million Americans are diagnosed with basal cell carcinoma every year. Most cases occur in people over the age of 50, and men are more likely to develop BCC than women.
What Are The Most Common Subtypes?
“There are two common types: nodular and superficial,” explains Rajni. She also points out the aggressive types of basal cell carcinoma include infiltrative, micronodular (which presents characteristics similar to those of the nodular subtype, except it’s comprised of multiple nodules), morpheaform, and basosquamous subtypes.
What Are Differences between Superficial and Nodular BCC?
Features of superficial BCC include clusters of basaloid cells descending from the epidermis with no dermal invasion.
The most common subtype, nodular basal cell carcinoma has islands of cells with peripheral palisading and a haphazard arrangement of the more central cells.
What Are the Characteristics of Morpheaform BCC?
Also known as sclerosing basal cell carcinoma, this aggressive subtype has spiky, basaloid, thin cell strands that chase down the dermis with its dense fibrous stroma. Differential diagnoses may include metastatic cancer, microcystic adnexal carcinoma, and desmoplastic trichoepithelioma.
What Are Clinical Symptoms of BCC?
Patients with basal cell carcinoma may experience:
- Sores that don’t heal
- Patches of skin that remain irritated and red
- A bump of skin that may resemble a mole but appears shiny, pink, or pearl-like in appearance
- An area where skin looks shiny and taut with poorly defined borders and a scar-like appearance
These symptoms are most likely to occur in areas often exposed to the sun, such as one’s face, neck, scalp, back, shoulders, ears, and chest. Other risk factors include Gorlin syndrome and nevus sebaceus.
Whether you’re in residency, studying for board exams, or a practicing dermatologist looking to stay sharp, the Digital Dermatopathology Digest video series is your informational and convenient source for dermatopathology review. Find the full series here.
