Brian Loftus, MD is a practicing neurologist at Texas-based Bellaire Neurology, where he sees close to 20 patients a day with the help of three medical assistants and one office administrator. The practice has used Aprima’s EHR for close to 14 years, and participated in Meaningful Use for three before backing out of the program. As Loftus explains, “It has now become a burden and not worth the extra time, as most of the clinical measures do not apply to headache therapy.”
Loftus is also CMO of iHeadache MD, a digital diary that enables patients to document headache symptoms and frequency, as well as securely share the data with their physician.
How have you seen healthcare IT improve patient access and outcomes? Is the practice working on any new implementations?
EHRs are good for tracking labs, making sure screening tests get performed, and patients make their follow-ups. They generally do not drive improved decision-making processes for most diseases; however, there is nothing about an EHR that specifically supports headache care. It does not make you a better physician. It does make for more legible notes, but if the MD does not type in what they are thinking, then they are no more useful than old handwritten notes when the doctor did not write down what they were thinking.
I type my notes while I am in the room with the patient. By the time they check out, my documentation is complete and they leave my office with a typed plan that states what we discussed about their care, what was done at the visit, a list of current medications, and a plan for follow-up.
Regarding implementations, we are working on integrating our depression, anxiety, and migraine disability assessment screening forms into our EHR. They will be saved as formatted data in the chart and then I can compare these scores over time. Patients will fill them out on an iPad when they arrive. We do not have a timeline established for this, but it is relatively easy and we should have it implemented by the end of the year. Our EHR has also released a brand new version, so we will be upgrading soon.
What prompted you to develop iHeadache?
I would ask patients to keep a headache diary and most could not keep up with a paper diary. They either forgot to fill it out or forgot to bring it to their appointment, so I saw the need for an electronic diary that they could carry with them all the time. As I did medical research studies, it was clear that we could bring quality of life metrics and treatment tracking that we did in studies to routine medical care. Therefore, my wife and I started Better QOL – Better Quality of Life. I was originally a chemical engineer who did computer process control programming for a couple of years before going to medical school, so I have an engineering and software background. We also have a third partner who devotes a lot of time and energy, does the nitty-gritty programming, and oversees a programmer we hired who lives up in New York.
We self funded the development of the app and as we receive funding from advertising, we have added features and over time developed iHeadache Online. My wife and I have not made any money from iHeadache; all profits from advertising are used to further development.
Do you foresee releasing new technologies via the iHeadache company? Will the company grow within the next few years? Do you anticipate gaining additional funding from outside investors?
iHeadache Online and iHeadache App do not sync at the moment, but we have nearly raised the funding to start programming a brand new iHeadache app as well as a mobile-enhanced website for people without iPhones . Both will sync with www.iHeadache.com so people will be able to enter headache data on their mobile devices as well as on the website.
We also started a non profit and our goal is to adapt iHeadache for research use so that fellows, residents, and physicians can use it for their own studies. We have also considered starting a pregnancy registry for headaches, and that may be our next endeavor after we finish developing the new iHeadache app. We would love to do more and develop a multiple sclerosis diary, a chronic pain diary, and diaries for other diseases, but we plan to grow organically as our time and finances allow.
As a private-practice physician, what are your biggest healthcare IT challenges?
Aprima is very good at supporting their product. Dell support has been very good when needed, but you do have to have someone to interface with them. Having IT you can call on only when needed is probably the biggest challenge for us. We do not have any need for ongoing IT work, but have needed it when we have upgraded servers. This issue is somewhat by choice. There is a VAR that will run Aprima as a service, and there is a VAR that will place and maintain a server in your office, but I have chosen to have my own server. I am probably more comfortable with this than most. I like not being dependent on the Internet to function and only having an onsite server allows this. I like the multiple levels of backup that we run and the offsite backups that we generate as well. I don’t like having something that is critical for my business to run day in and day out to be dependent on another company. I have had one down day due to server issues in the eight years of my practice.
What best practices would you offer colleagues facing similar situations?
Because most EHR vendors will go out of business, I strongly recommend you use a service that has a server in your office and, if needed, use an outside company to help maintain it. Besides the server’s built-in raid functions, you should have backups. A mirrored drive is not a backup. I back up nightly to one drive, and backup up weekly to a second onsite drive and offsite storage as well. Given how cheap hard drives are these days, the weekly backups will go back for months, and then a monthly backup will be kept for a couple of years in case it is important to get back to something that gets deleted and changed accidentally. In eight years, I have only gone back to a remote backup once, so maybe all of this is overkill. On the other hand, I can remember a company that went out of business because they did not understand the difference between mirroring and backups. There are medical practices that have lost charts due to flooding or fire. There is no reason why this should happen anymore. Of course, all backups should be encrypted whether they are stored onsite or offsite.
For my practice in general – we have been moving to an out-of-network model and charging reasonable prices to become less dependent on payers. Headache medicine has few procedures, and for the most part, we are being paid for our time and our thinking abilities. Insurance has traditionally paid poorly for this. By charging reasonable amounts and offering services not typically found at other practices, I can run the kind of practice I want to have.