Will Robots Replace Healthcare Providers?

Khal Rai

Khal Rai

Senior Vice President, Development at SRS Health
Khal oversees the Software Engineering, Business Analysis, Quality Assurance, and Product Management teams at SRS. His 17+ years’ experience in software development and healthcare IT have resulted in a true passion for collaborating with customers, then translating their needs into innovative solutions and better service experiences. He believes that motivated employees and satisfied customers are keys to maintaining business success. He has a B.S. degree in Computer Engineering from the University of Cincinnati, and an M.S. degree in Electrical Engineering from Purdue University.
Khal Rai

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robot-blogLeveraging interpretive intelligence in clinical workflows

Automation has been making human workers superfluous for centuries, but until recently, workers whose jobs required high-level cognitive skills have been able to rest easy, confident no machine could possibly replace them when it came to making nuanced decisions based on the evaluation of complicated, sometimes contradictory data.

But that was before Artificial Intelligence (AI) came along, stepping out of the pages of science fiction and into our daily lives. It now seems possible — even probable — machines will replace many mid-level knowledge workers and the question arises whether someday robots will replace doctors and nurses.

It’s a provocative question, certainly, but not the most interesting one facing our industry. A more critical question is will the healthcare ecosystem — the vendors and the solution providers — be able to survive without AI? I ask this because I believe doctors and healthcare administrators will increasingly demand answers to questions, and solutions to the challenges, that are difficult, if not impossible, to solve without the aid of AI-driven solutions.

These questions will range from practical issues of practice management to vital questions of patients’ health. For example:

  • How much will it cost to treat this patient?
  • How much and how fast will I get paid?
  • Is medication or surgery the best treatment option for this particular patient?
  • Where and/or when should I schedule this surgery?
  • When will this patient be able to return to his/her normal routine?

Some of these, of course, are the perennial questions that have always faced healthcare practitioners, but the truth is recent changes in technology have made innovative solutions possible in a way never before imaginable. For example, all kinds of data are now readily available in consumable (discrete) forms — from PHI to financials to protocols — and storing and managing this data is getting cheaper every day.

Additionally, healthcare providers are beginning to understand the shift from service to value-based care and are seeing how it can work for them, both clinically and financially. Finally, the healthcare practitioners themselves are changing: computer- and technology-savvy clinicians who got their medical education and training in the 1990s and early 2000s (the so-called Generation X and Y) are now entering into leadership positions where they can affect change.

In other words, there is both a greater supply of data than ever before and a greater demand for it. However, this demand isn’t simply for large data-dumps of undigested information. What’s necessary is for healthcare providers and administrators to have the critical data they need, and only the data they need, when and where and in the form they need it. This is where AI can help make critical decisions about amalgamating and filtering data.

There’s enormous potential for AI (or “smart solutions”) to optimize clinical protocols by drawing on a huge pool of evidence-based results. As we move toward a value-based environment, AI will be increasingly necessary to proactively and dynamically manage patient outcomes. This, in turn, will optimize the treatment experience, leading to greater patient engagement — and this greater continuity of care will promote both healthier patients and healthier practices. Clinicians will also gain insights into how to manage risks, which leads to lower costs and better margins.

Will robots replace healthcare providers? It seems unlikely, but care teams will start to leverage interpretive intelligence in daily clinical workflow. Machine learning, along with AI, will become an integral part of the healthcare mix because the vast resources of critical data will only be truly available when clinicians have tools to track real-time data embedded in their daily workflows resulting in better patient care at a lower cost.

As seen in Health IT Outcomes.

The True Cost of Patient Registration Errors

The true cost of patient registration is hard to analyze because most providers and hospitals have convinced themselves they need to handle patient registration, instead of the patient handling it themselves. Therefore, the cost for patient registration can’t be improved and constantly increases based on new industry standards, such as meaningful use questions and ever-increasing staff costs. The result of this attitude and approach is that patient registration often takes more time than necessary. If the patient is unable to control his or her data during the registration process, lengthy wait times and increased dissatisfaction occur—costing providers both time and money.

Patients, on average, spend about 20 minutes in waiting rooms of healthcare organizations. When these organizations don’t focus on streamlining the patient check-in process, patient throughput suffers. Staffing expenses increase because staff must take time to clarify patient data or fill in missing pieces at the point of service. In addition, the potential for denied claims is higher due to a lack of data verification, raising overall collection costs.Impatiently-Waiting

Today, just 5 to 10 percent of healthcare organizations offer self-service solutions for patient registration and check-in. This is a missed opportunity to improve patient satisfaction, reduce costs and increase revenue. There are three benefits of self-service check-in technologies healthcare leaders should consider.

Speed. At Montgomery Cancer Center in Montgomery, Alabama, an electronic patient check-in solution decreased patient check-in time to just 41 seconds. Putting the registration process in the hands of patients not only provides them with the ability to manage their experience, but also limits check-in time simply by eliminating a visit to the front desk. This increases patient throughput and ensures that the time staff does spend with patients is of higher value.

Consider the airport registration process. When passengers fly, the last place they want to go to is a desk staffed by an airline employee. Instead, the first stop is to a kiosk or a mobile application with built-in technology that recognizes individuals with the touch of a few buttons, thanks to information they have been able to input in advance.

The experience in most hospitals and physician practices is often the opposite. Patient check-in is heavily dependent on staff—and breakdowns in processes occur when staff call in sick. They also occur when staff follow the same steps for each patient rather than customizing the registration process to the patient’s situation and needs. This increases the potential for error, which can lead to lost revenue.

Some hospitals and physician practices have tried to automate the registration process with the use of tablets rather than self-service platforms that verify data in real-time. However, this approach has critical flaws. For example, to receive a tablet, patients must go to the front desk, just as with traditional, manual processes, and any front-desk encounter adds time to the visit and costs hospitals and physician practices money. Every patient visit to the front-desk is an incremental cost for the hospital or physician.

Patient experience. Why is it that patients spend more time in the front office than with their physician or a nurse? It’s because front-office processes are broken. When patients spend more time than necessary dealing with a provider’s front-office processes and staff, satisfaction plummets—and there is a cost to lost patient loyalty.

One of the biggest misconceptions in healthcare is that front-office staff in physician practices and hospitals provide a personal touch to the patient encounter. But think about what this encounter typically looks like: “We have a few questions we need you to answer. Here is your paperwork [or tablet]. Please return this with your insurance card and driver’s license …” Is this really the personal touch we’re seeking to provide in healthcare?

Meanwhile, patients complain about the amount of paperwork they must complete before being seen by a physician. The personal touch they want is time spent with their physician. Anything that impedes their ability to see their physician impacts their experience.

Ideally, patients should spend two minutes or less on registration activities when they arrive for their appointment. While the amount of time spent at check in will vary by specialty, look for a self-service check-in solution that can ensure a two-minutes-or-less process.

Improved communication. So often in healthcare, it appears no one has time to truly talk with patients. Front-desk staff don’t always have the experience or time to have a meaningful conversation with patients. Nurses and technicians are under too much pressure to move patients through processes quickly. When the patient does see a physician, the backlog of patients—stemming in part from inefficient check-in processes—limits time for a meaningful encounter beyond the reason for the visit at hand.

Yet studies consistently show that the quality of patient communication has a direct impact on patient satisfaction. Effective communication is critical to the patient experience, which is now measured and tied to value-based payments. It’s also vital to understanding the patient’s total health needs and managing the patient’s health beyond a single episode of care.

A self-service check-in process opens the door to more meaningful communication with patients not just by freeing up staff time, but also by improving throughput. For example, nurses and physicians are better able to share information about additional services the patient may wish to consider. Staff can then augment these conversations by providing patients with brochures that offer greater detail about these services. Staff time also can be spent on patient follow up, making sure discharge instructions are clear and future appointments are scheduled.

Additionally, a self-service check-in solution offers real-time authentication of data and the opportunity to survey patients. Communicating financial information to patients can’t be done through the current paper process; however, when a patient uses a digital check-in solution, their data can be immediately authenticated, which allows for immediate communication of copays and remaining deductibles. Patients can also relate their experience with a staff member or physician in a post-office visit survey to actively share their suggestions for practice improvement. Not only do patients feel listened to, but their suggestions also help providers increase satisfaction and value.

Reengineering the patient registration experience is critical to eliminating front-office errors and delays that cost healthcare organizations money. It’s also essential to creating a more positive experience for patients as well as staff—a key step toward improving value.

 

gerard-white-clearwaveSRS Health guest blogger: Gerard White, President & CEO of Clearwave

With 20 years of technology leadership experience, Mr. White is responsible for successfully implementing the Clearwave Corporation vision and strategy. Mr. White co-founded the company in 2004 to carry out a vision of technology that spans the healthcare continuum through the creation of a healthcare network and a single patient identifier that allows accurate patient data to be shared regardless of what provider a patient visits.

Mr. White has extensive experience working with some of the most respected companies in the world including EDS, Security Mutual, Saturn, Lennox Industries, Continental Airlines, GTE, Alltel, Hitachi, Grant Thornton and Blue Cross Blue Shield. Both his knowledge and leadership experience provide a solid groundwork for Clearwave Corporation’s active role in revolutionizing the healthcare industry.

Prior to joining Clearwave, Mr. White was the CEO of 1stOrder, focusing on IT consulting services and wireless application development. He holds a Bachelor of Science degree in Business Management and a Bachelor of Applied Science degree in Information Systems.

If You Build It, Will They Come?

Luis Marcos

Luis Marcos

Senior Operations Manager at SRS Health
Luis began his tenure with SRS-Health nearly 8 years ago as an Implementation Specialist. In that time, his attention to detail and planning garnered accolades from clients and colleagues alike, making him a star within the department. In 2015, he shifted his attention to organizational project management with an emphasis on operational efficiency while overseeing activities in Professional Services. His focus shifted in mid-2016 and he now oversees the activities of both the Support and Service Delivery Teams.
Luis Marcos

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Let’s take a moment and talk about the ideal development-to-adoption scenario. For the sake of the exercise, you’re Kevin Costner. You hear a whisper about building it. You continue to explore what it is until you realize that you have been asked to build a baseball field. Through hard work and perseverance, the request becomes reality. In no time at all, ghost baseball players emerge from behind corn stalks and play a game.

That right there folks, is the dream of every software developer. They aspire to build what you need and then have you faithfully use their creation. Alas, like Field of Dreams (beautiful film), that aspiration typically falls under the genre of fantasy.

How can that be? Why wouldn’t a user take advantage of an enhancement to their software? Truth be told, there are number of reasons as to why, including, but not limited to:

  1. Lack of awareness.
  2. Aversion to change.
  3. The functionality doesn’t meet your exact needs.
  4. The perceived effort of deploying the change outweighs the benefit.

As an end user, you should want and need to maximize the feature set that your software has to offer. Why is this so important? In the graphic below, I have listed only a few of the ways that software enhancements can impact the bottom-line.

improved-bottom-line-700px

As I challenge myself to seamlessly interject concepts from other cherished feature films, this is where I say, “Help me, help you!” When it comes to your software, aspire to A.C.E. the experience.

Accountability: Appoint an Internal Software Administrator (ISA). This person would be responsible for forging a relationship with your software vendor(s). They need to be familiar with the vendor’s release cycle and understand what each new version has to offer. They would then be responsible for scheduling recurring meetings with key stakeholders to discuss their findings and recommendations. They should also volunteer to participate in any focus groups that your vendor may offer. This is a great way to ensure that your vendor understands the specific needs of your organization and how they fit into the big picture.

Collaboration:  Who are these “key stakeholders” that I mentioned above? They would be your Change Control Board (CCB). This group should be comprised of members of each functional department of your business, as changes may have ripple effects throughout the organization. Affecting change is often easier when the decision is made jointly as initial buy-in will be stronger.

Execute: Assuming the CCB finds value in certain enhancements, develop a plan to implement them. This will often involve initial training, shadowing and follow-up that could span a few weeks. Remember that each implemented change is a deviation to someone’s routine. Depending on the work flow adjustment required, a fair degree of staff coaching may be involved.

In fairness, I realize that I’m making all of this sound really easy. It’s work and it requires commitment. Alas, if it means that you can add to your bottom-line, become more efficient or play a round of catch with “Shoeless” Joe Jackson, it is worth exploring.

Now go A.C.E. your experience!

You Say You Want a Revolution…

Ryan Newsome

Ryan Newsome

Vice President of Software Engineering at SRS Health
Prior to joining SRS almost 10 years ago, Ryan started his career as a software engineer for Map Info/Pitney Bowes. Throughout the years Ryan has been an expert in all things web, interoperability, and in agile leadership. He currently oversees all of product engineering at SRS and has led SRS’ transition to an Agile/Scrum Development Methodology. In his free time, you can find Ryan either skiing, cycling or spending time with his family. Fun Fact: Ryan played Division 1 Soccer at Sienna where he attended on a scholarship. Goal!
Ryan Newsome

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This past February, SRS Health sponsored its third annual hackathon. Hackathons are the proving grounds for new ideas. These events stimulate creativity and encourage risk-taking to develop innovative solutions to new or persistent problems.Hackathon Blog ImageThis year’s hackathon was organized around the theme of Data Revolution, and when you think about it, there’s a revolutionary quality to the very idea of hackathons. The word “hackathon” is a portmanteau of the words “hack” and “marathon,” where “hack” is used in the sense of exploratory programming. It’s this exploratory aspect of hackathons that enables participants to be super creative, push boundaries, think outside-of-the-box and develop revolutionary ideas. We solicit ideas from customers and SRSers that can range from practical enhancements to futuristic solutions for tomorrow’s problems.

At SRS Health, we’ve noticed some strong benefits to running hackathons:

  • Feedback – If our product is going to help solve your problems, we need to know what those problems are. Hackathons allow us to discover problems and explore solutions.
  • Engagement – Hackathons build team and community spirit. Participants have fun, and they get a chance to collaborate with others with whom they don’t typically work with on a daily basis.
  • Diversity – Having a wide range of participants generates a variety of fresh perspectives, both on existing problems and for future possibilities.

The result? An event filled with fun, high-energy, free food, great ideas, engaging presentations and amazingly talented people. There are a number of concepts that we are very excited about and could make its way into future editions of our products.

So, if you have a revolutionary idea that you’d like to see become part of our product—or even just an evolutionary step that fixes a chronic problem—let us know about it. It may be the perfect candidate for our next hackathon. The truth is, we all want to change the world of healthcare, and we’d love to explore and define that future together with you!

 

 

 

The Importance of Flexible Technology in High-Performance Practices

Adam Curran

Adam Curran

Product Marketing Manager at SRS Health
Adam Curran is a Product Marketing Manager at SRS. He oversees marketing intelligence to support the development of strategic marketing plans. Prior to joining the organization, he was a key member of a pharmaceutical software company’s Clinical Development Business Unit, specializing in the clinical data management elements of the drug development lifecycle. He was also the editor for their microsite’s blog. Adam has also held roles at the UK’s National Energy Foundation and Skills Funding Agency.
Adam Curran

flexible-tech-blogAn article posted recently to LinkedIn—about the jobs most and least likely to fall victim to robot replacements—started me thinking about the place of technology in healthcare. One takeaway from the article is that automation is best deployed for tasks that are manually or cognitively repetitive, freeing humans to specialize in tasks that are non-repetitive and non-predictable, ones the writer describes as requiring “human intuition, reasoning, empathy and emotion.”[1]

That was exactly the promise of electronic health record (EHR) technology—routine bureaucratic tasks would be automated, freeing doctors and staff to do what they do best: treat patients. Yet in a recent study published in the Annals of Internal Medicine, ambulatory physicians spent an average of a full hour at the computer for every hour they spent face to face with patients.[2] Imagine automating a factory and discovering that workers now worked twice as long, or produced half as much, because of the time required by the new technology that was supposed to reduce their workload.

Paradoxically, with recent advances in technology, it is now more possible than ever for EHRs to fulfill their original promise—and more; the problem is that most of the EHRs being offered to medical practices are simply the wrong technology. In an attempt to meet standardized government regulations, vendors have created standardized EHRs—gigantic, one-size-fits-all behemoths that attempt to meet the needs of all physicians, but end up missing the mark with nearly everyone. Particularly when it comes to specialists. KLAS’ Ambulatory Specialty 2016—One Size Does Not Fit All—Performance Report found that although traditional EHR vendors try to cover all specialties, fields like ophthalmology, orthopedics, and dermatology still lack the functionality required.[3]

This is why one size definitely does not fit all. The right EHR solution for a hospital or general practitioner, seeing a limited number of patents with a wide variety of conditions, will look quite different from the EHR for specialists who see a high volume of patents with similar complaints. And of course, different specialties won’t want exactly the same EHR, either, making flexibility—rather than universal applicability—a major prerequisite.

No wonder that 86% of specialists, according to Black Book Market Research, agree that the single biggest trend in technology replacements these days is the move to specialty-driven EHRs because of the workflow and productivity complications that accompany conventional, template-driven EHRs.[4]

Unfortunately, the problems with inflexible, template-driven EHRs don’t end with the lack of specialty-specific solutions. A secondary, but still significant, concern is the inability of many EHRs to be tailored to the need of individual physicians within the practice. One doctor may prefer taking notes, another inputs her own data, while a third dictates; one may be comfortable communicating through a patent portal, another prefers the phone. True flexibility means that no provider has to change the way that he or she has been practicing medicine simply to satisfy the demands of a generic template.

It also means that, when it comes to increasingly crucial matter of data collection, the decision about how data should be collected—what should be collected electronically and which should remain manual—is left up to the individual practice. In the next blog, I will look at what is called “role-based data entry,” and how this can increase productivity and cut costs.


 

[1] https://www.linkedin.com/pulse/5-jobs-robots-take-first-shelly-palmer

[2] http://annals.org/article.aspx?articleid=2546704

[3] Ambulatory Specialty 2016—One Size Does Not Fit All—Performance Report. KLAS. April 2016.

[4] https://blackbookmarketresearch.newswire.com/news/specialty-driven-ehrs-make-a-comeback-reveals-2016-black-book-11534546

Outcomes: It’s What’s Inside That Counts

Scott Ciccarelli

Scott Ciccarelli

CEO at SRS Health
Scott Ciccarelli, Chief Executive Officer at SRS, has more than 20 years of diverse management and operations experience garnered as a senior executive at GE, where he headed two of the company’s businesses—most recently, GE Healthcare’s Services, Ambulatory and Revenue Cycle Solutions. His areas of expertise include business strategy, leadership development, operational rigor (Lean Six Sigma), and the delivery of enhanced value for customers through quality improvement and innovation.
Scott Ciccarelli

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lightbulb-gears-blogTwo weeks ago, more than 40,000 people came together to network, share, and learn more about health data management at HIMSS17. As expected, we heard about the latest developments in top tech trends of tomorrow like artificial intelligence, data security and virtual care. One of the hottest discussion topics by this highly focused group was how to improve patient and practice health through meaningful and usable analytics. After much time listening to and participating in conversations on this critical subject matter, we are more committed than ever to helping our clients improve patient care through outcomes, and when it comes to outcomes, it’s what’s inside that counts.

What do I mean by that? This familiar phrase has been shared from generation to generation when describing what’s important about people. So how can these words of wisdom about humanity possibly apply to HCIT and outcomes for specialty medicine practices? It’s more appropriate than you might think…

In an ambulatory setting, specialist teams need the ability to analyze and make decisions within their HCIT ecosystem. They need insight within their workflow. They need to know how to deliver the best care at a lower cost. And the only way to do this in today’s data-driven world is by bringing insight and analytics inside their workflow. Not outside.

External solutions focus on providing isolated results rather than a holistic approach to patient and practice health. What’s an outside solution? It’s anything that requires you to offload data, thereby taking you out of the ecosphere. If that data is not contained in the ecosphere – if the information is not inside the workflow – these solutions are not actionable immediately.

We believe that the only way to achieve the best outcomes is through frictionless data solutions that provide actionable insights that net immediate, holistic results. Of course, too much data can be overwhelming, so how do we maximize data intelligence for specialists without disrupting the quality of patient care?

That very question is what led to the development of SRS EHR Smart Workflows®. We’ve replaced complexity with streamlined data relevancy in a way that helps provide the frictionless clinical experience of the future…today.

So while we continue to hear all about the amazing healthcare technologies that are on the horizon, let’s remember to turn our gaze inward. Because when it comes to best outcomes, the best solutions are about what is on the inside. Just like the best people.

The Year’s Innovations – Wrap-up & What’s to Come!

Khal Rai

Khal Rai

Senior Vice President, Development at SRS Health
Khal oversees the Software Engineering, Business Analysis, Quality Assurance, and Product Management teams at SRS. His 17+ years’ experience in software development and healthcare IT have resulted in a true passion for collaborating with customers, then translating their needs into innovative solutions and better service experiences. He believes that motivated employees and satisfied customers are keys to maintaining business success. He has a B.S. degree in Computer Engineering from the University of Cincinnati, and an M.S. degree in Electrical Engineering from Purdue University.
Khal Rai

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2017-lightbulbsDepending on your point of view, 2016 was either a year to remember, or one to forget—just look at the nominations for word of the year. Pundits have proposed everything from “surreal” (Merriam-Webster’s) to “post-truth” (Oxford Dictionaries) to “unhinged” (NPR’s books editor Petra Mayer). Which is just to say, it was a year when conventional expectations were overthrown. And 2017 promises to be just as full of surprises.

For all the uncertainty, though, some trends seem sure to continue, at least in healthcare. The movement toward value-based payment is unlikely to reverse itself, which means that the optimum long-term strategy for medical practices remains the same as last year—cut costs by increasing efficiency, maximize patient base by identifying and standardizing successful treatment approaches, and stay limber by not getting locked into a cumbersome, inflexible software system.

Over the years, we have worked closely with our clients to learn what they needed from us, and to gain the sort of specialty-specific expertise that ensures that our solutions are designed around our clients’ workflows, rather expecting them to tailor their workflows to our design.

This past year, however, has been particularly transformative. We have made a quantum leap forward by upgrading our EHR into something far more—an intelligent, data-focused solution that responds to today’s industry challenges and lays a solid but flexible groundwork for the future. It’s a unique, best-of-breed, specialty-focused approach that gives users the power to define and collect whatever data points are relevant to their success while still maintaining their preferred clinical workflow options.

What we have achieved so far – 2016 recap

We entered last year determined to expand our physician-centric approach to include all stakeholders in the outpatient healthcare delivery system. Because we put our clients’ requirements first, we had to take a fresh look at what their needs actually were in this changing landscape. The biggest need? Tools to capture the data they wanted, but only that data, without anything unnecessary that would distract from their primary focus. (Click here to read my other post about how we do data differently.) We realized that, to meet those needs, we had to transform our offering into more than just an EHR.

We achieved this by creating a  connected software system that lets practices distribute the data-collection process over the entire treatment encounter—before, during, and after the patient visit—in whatever way is most efficient and sensible for them. Here is what we have delivered:

  • Flexible Data Platform (FDP) – Discrete data collection and reporting, free from a forced template-based environment.
  • Smart Workflows (SWF) – Guided workflow to help practices optimize their daily schedules by letting them determine who does what best, where and when.
  • Patient engagement platform – A patient-portal solution that seamlessly engages the patient pre-visit. Success is measured by higher patient compliance, lower check-in costs to practices, and greater patient engagement in their own health post-patient visit.
  • Interoperability – An Application Program Interface (API) that allows for efficient data exchange between systems, and that gives practices the flexibility to choose the best solution to any given problem (e.g., clinical, financial) without sacrificing cost and/or productivity.

What’s next? – Even more data!

We have already laid the foundation for what is required today and tomorrow. The next step is to ensure that we maximize the value of what we offer by providing the following additions to fulfill our vision:

  • Regulatory compliance – Prepare clients to understand, comply, and succeed while retaining productivity and efficiency focus (e.g., MU / MIPS, AMC, PQRS reporting).
  • Outcomes – Invest in solutions and technologies to help practices drive, improve, and document clinical outcomes to improve patient care and increase reimbursements
  • Data and AI – Continue to optimize SRS’s recently released SWF and FDP solutions to leverage data and artificial intelligence to optimize clinical workflows.

We understand that no two practices are alike—they all have different rates and style of data collection. One practice may need to automate everything immediately, while another may only automate elements that will drive down costs, and decide to keep other processes manual. Our solution is designed with this level of flexibility in mind—to satisfy each practice’s requirements for today while having the functionality to support their evolving needs in the future.

Wrapping it up

The underlying SRS strategy is a physician-centric approach we call “practical innovation.” We are more than just a solutions vendor . . . we focus on finding a solution to the specific challenges facing specialists. We partner with practices to solve their actual business problems—we help them stay independent, drive revenue growth, lower costs, stay compliant with regulations, and demonstrate clinical quality.

If you’re looking for a partner who will really listen to you and understand your needs, who will help engage your patients and produce better clinical outcomes, who will keep your practice competitive in a changing environment, then SRS is your partner of choice—for today, and for whatever unpredictable tomorrow awaits us down the road.