Louisiana-based solo practitioner uses information technology to make a difference in his medical practice.

Twenty years ago, Neil Notaroberto was an accomplished and well-paid computer programmer. He liked his work and he enjoyed information technology, but sitting in an office all day was, at best, not his proverbial cup of tea.

Louisiana-based solo practitioner uses information technology to make a difference in his medical practice.

Twenty years ago, Neil Notaroberto was an accomplished and well-paid computer programmer. He liked his work and he enjoyed information technology, but sitting in an office all day was, at best, not his proverbial cup of tea.

Then, through a project affiliation with the Oregon Health & Sciences University, he gained the opportunity to spend substantially more time with physicians, a career choice he had considered earlier in life, but one that lost out to computer science. One neurosurgeon in particular impressed him, and Notaroberto thought, “This guy is making a difference in the world. I need to do that.”

Today, Neil F. Notaroberto, M.D., is a solo practitioner and ophthalmologist. His EyeCare 20/20 practice enjoys two practice locations in Slidell and Harahan, La. Immediately after the Oregon experience, Notaroberto left computer programming, returned to graduate school and then proceeded through medical school. He considers himself fortunate to have had two dramatically different and rewarding careers, and the first career has dutifully provided him with a strong business foundation for his second career.

The Business of Medicine
In some ways, Notaroberto is like thousands of other U.S. physicians, working in a solo practice or a small practice of two or three doctors. But in one major way—his IT training and work experience—he is unlike most other physicians.

In 2004, he decided to search out a new practice management (PM) system that would allow him to outsource CPU load to free up processing space, reduce his total cost of IT ownership and support his desire for off-site data management as part of a disaster prevention plan. After considering several server-based and Web-based systems, he selected NueMD from Nuesoft Technologies in Marietta, Ga. The product’s Java-based interface and low cost were two primary factors that influenced his choice.

Moving to an Internet-based system was a critical decision, complete with positives and negatives. “There is no foolproof way to make such a decision,” he says. “With a server-based PM system, the practice is locked into proprietary software and even hardware that must be serviced by the supplier. Significant issues, like cost containment and portability, are outside of your control.”

The first obligation of a medical practitioner, says Notaroberto, is to take the best care possible of his patients. After that, he acknowledges that the practicalities of also running a medical practice as a business play a role. “Medicine is a business of data acquisition and data management on behalf of patients. You have to buy the best equipment to take care of both your patients and your business, and you have to watch costs without sacrificing any elements of quality patient care.”

Notaroberto admits that even ASPs (application service providers) have a downside: They are broadband dependent. He addresses that with contingency-based planning and redundancy, and with two methods of data access. “If one is down with one provider, we have an alternative. In addition, all our data is redundantly backed up,” both with Nuesoft and a second service provider in California.

Back in 2004, expandability and portability were among Notaroberto’s top systems concerns, as well as trying to rein in expenses. Today, he uses a laptop that travels with him to the hospital or home, or even to an Internet café, with which he can access data. His business has expanded substantially, and he finds the system well able to handle the increased demands.

Smile, You’re on EyeCam
NueMD gives EyeCare 20/20 the registration, insurance eligibility and verification, scheduling, claims, billing and reconciliation functionalities that a practice would expect from a PM system. But Notaroberto also used the PM system for deliberate process improvement within the practice’s workflow, and he achieved results to write home about.

He set the system to monitor patient flow in the office, using a live Web cam and a medically trained auditor, who is also a C.P.A., at a remote location. NueMD, he says, supports an extremely detailed time analysis. “We looked at everything from the moment the patient arrived, through check-in, through being seen by the physician and right through check-out. We wanted to see exactly how long a patient has been at each stage, and what might slow me up or slow up my nurse. Just examining those four points of data—and we examined more than four—we were able to identify exactly where the bottlenecks occurred.”

His auditor was already familiar with the NueMD system, so a learning curve wasn’t at issue. But Notaroberto says that even an auditor not trained on the system could be brought up to speed in a day or two. As it happened, EyeCare 20/20’s audit was only one day long and, “We didn’t even need the Web cam. We knew within the first day what needed to change,” he says. The practice made the necessary workflow changes and “we saw results within a week.” Essentially, a long wait time—one that could stretch to two hours or possibly beyond—was reduced to the 30- to 40-minute range within one week. That allowed Notaroberto to increase his patient flow by 25 percent almost instantly, a dramatic increase for a solo practitioner.

Web Benefits
An instant and significant Web-related benefit for Eye­Care 20/20 was freeing up a dedicated server room at one of the office locations, since NueMD is an ASP system. Server space was converted into patient space, so patients can be moved through their medical visit faster. In addition, Notaroberto eliminated technical support expenses of $8,500 annually for his previous server-based system. His $1,200 annual upkeep and maintenance cost in 2004 decreased to $800 in 2005.

But the big money difference appeared in reimbursements. The NueMD system “puts data together concentrically,” says Notaroberto, “like the hub of a wheel connecting with its spokes.” That capture, collection and manipulation of data make it easier to get bills out the door faster and with fewer pending or denied claims as a result. With increased patient flow and a faster billing system, EyeCare 20/20 generated a $30,000 revenue increase from 2004 to 2005.

Only a few years ago, healthcare providers of all types—community hospitals, integrated delivery networks and physician practices—were skeptical of ASP systems. Who wanted to part with their data? Who wanted their data to reside thousands of miles away in vendor-owned data centers? Rarely has a fear like this become so yesterday so fast, especially in a sector as slow to adopt as healthcare.

Today, one of the acknowledged benefits of using ASPs is the storage, security and safety of a practice’s data housed miles away in vendor-owned data centers. No one knows that better than Notaroberto, whose data is stored in Nuesoft data centers. EyeCare 20/20’s two office locations, in Slidell and Harahan, La., saw Hurricane Katrina roar through the gulf coast region in late August 2005. “A lot of my colleagues lost everything. All of their medical records were permanently destroyed,” he says. “They have had to start a new practice from scratch or have gone to work elsewhere.”

With his practice data intact, Notaroberto was the only ophthalmologist in the New Orleans metropolitan region who saw patients in September 2005. “We began seeing patients within 16 or 17 days after Katrina,” he says, “and we were fully operational by September 22.” In fact, between mid-September and mid-October 2005, he saw more patients than all of the other eye specialists in the surrounding region. He was the first community physician in any specialty to begin operating in the local surgery center following the hurricane.

The category 4 storm changed his business, too. He increased from seeing 21 to 27 patients per day before Katrina to seeing 31 to 39 patients per day following Katrina.

The true win-wins in life are few, but Notaroberto’s case definitely is one. Medicine gained a dedicated practitioner who had already enjoyed career success in a scientific but vastly different field. EyeCare 20/20 acquired an ASP practice management system that delivers the technical prowess and disaster preparedness that a former computer programmer requires. Patients in the New Orleans metro region gained a tech-savvy and talented ophthalmologist who can delivery quality care in the most challenging of circumstances. They have seen the proof.

For more information about NueMD from Nuesoft Technologies,