Practice Excellence in Two Clicks
of a Mouse
Let high technology information systems empower your practice.
BY SCOT MORRIS, O.D., F.A.A.O., Conifer, Colo.
Compared to the first electronic medical records (EMRs) of years ago, paper medical records must have
appeared efficient. But today, software programs perform complex tasks in an instant, including practice management activities such as billing, coding, marketing, audits, etc.
Driving this advance in medical office technology is an emphasis on cost-benefit analysis, outcome assessment and patient satisfaction. The medical industry is pushing providers toward electronic media, electronic filing and, ultimately, EMRs. (Vision Service Plan gives a credit for electronic claim filing and charges a fee for filing
paper claims.) The reason: Unlike paper claims processing, computers process claims without significant cost.
With EMRs, we can now access vital information within seconds. These powerful tools are changing the way we practice by making doctors better business people.
Behind the name
EMRs are digital medical records. Many systems have integrated practice management software (PMS) with EMRs to increase efficiency and productivity throughout the office. With just two clicks of a mouse, these combined electronic practice management systems (EPMSs) -- commonly but falsely referred to as EMRs -- replace the hours of work for paper charts.
Our society has embraced PDAs, TIVOs, DVDs, LCD TVs, etc. Patients expect you, their eyecare professional, to have state-of-the-art technology. From a marketing perspective, an EPMS has many advantages.
You can enhance the day-to-day internal marketing that centers on patient care.
► An EPMS allows for more quality time, better service, higher perceived quality of care and less time scribbling notes.
These systems can target specific patient demographics with detailed marketing pieces and track leads given by other patients about prospective new patients or businesses.
You can even send thank-you notes by e-mail before the patient leaves your office.
Talk about a competitive advantage over your colleagues who haven't taken the next step!
Don't get me wrong -- transitioning to an EPMS is a paradigm shift. You (and your staff) have to embrace the concept for it to succeed. It may not change the amount of time you spend with each patient, but it will change how you spend that time.
The most common use of the various EPMSs is in patient services and the clinical setting. Needless to say, patients value their time. With some systems, patients can register themselves electronically before they arrive at your office through a registration section on your Web page. While the patient is in the lane, your staff can schedule appointments, generate medical and optical scripts and even send standardized post-op or referral letters via e-mail.
All of these activities streamline each patient encounter and increase practice efficiency by cutting out various steps in the workflow process. EPMSs allow for automatic recall to enhance patient retention. Many systems can prevent life-threatening drug interactions with drug-interaction software.
You can even draw pictures just as you would on paper (except now they're actually legible). You can also import topography, visual fields, scanning laser ophthalmoscopes, autorefractions, keratometry, etc., which saves time as well as multiple print cartridges and reams of paper. You can also capture a short video of informed consent, if desired. Some EPMSs even compute service level codes based on the exam fields completed, thus optimizing the coding levels selected.
From the optical perspective, imagine managing inventory or tracking glasses and contact lens orders instantly. Many of the EPMSs even have direct interfaces with the major optical labs, allowing for tighter quality control and quicker job processing. Many software systems can track a patient's previous purchasing habits and make suggestions as to possible patient preferences, which enables the optician to make better eyewear suggestions.
Other advantages to using EPMSs include less physical chart storage space, increased free time for doctors, reduced transcription and printing expenses, reduced staffing and improved collections. In addition, EPMSs allow for immediate access to personnel data including salary, benefits, paid time off, date of hire and performance evaluations. You can also access immediate snapshots of your finances. You can track provider productivity in terms of charges and collections by provider and/or by insurance company, etc.
Additionally, you can track number of visits by provider, accounts receivable, accounts payable, adjustments, etc. You can file claims electronically with Medicare and third-party payers. These activities save time, reduce documentation and transposition errors, improve efficiency and provide better care for our patients.
Perhaps you're asking yourself whether you could afford to bring an EPMS into your practice, but a better question is, "Can you afford not to?" Consider this: A staff member needs to pull a chart, insert a new exam sheet and then file the chart after the completion of the patient visit. This scenario may replay 10 to 50 times each day, depending on your practice size. This staffer has to perform similar tasks not only for today's exams, but also for patients who require a prescription refill, a referral or even an answer to a question. This process can take two to three staff hours each day. How much is this worth?
Experts estimate that an EPMS can shave two minutes from each exam and an additional five minutes in chart search. This represents about $12 per exam including personnel costs. The increased efficiency in workflow is immeasurable.
Each doctor may see two to three more patients each day or perform the same tasks with one less employee. (Decreasing staff shouldn't be a principle goal -- you may be able to reallocate personnel resources rather than hire another person.)
As I mentioned earlier, many insurance companies provide incentives to file electronically.
Caveat: Integrating an EPMS isn't cheap on the front side. It is an investment that will pay for itself over time both economically and in terms of work flow efficiency. The biggest land mine to avoid is the hardware and training costs associated with the transition. Get detailed quotes from vendors and from information technology (IT) people on these items. Also plan to replace equipment and update hardware/software every few years, which, keep in mind, is still less expensive than hiring more staff.
Also consider how many reams of paper you bought last year (the average practice spends $.04 for each page of paper used in the office). Include the cost of those pricey printer cartridges.
Moving ahead with an EPMS
Once you finally decide to implement an EPMS system into your own practice, know that you'll have to understand the following.
Hardware. Computer systems have improved tremendously in terms of power, processor speed, storage capacity and memory. Place a workstation in every area of your practice where you'll look at a patient record. Doing so may give you more workstations than you currently have, but it's well worth the relatively minor expense.
In addition, plan for a dedicated office server to store, process and distribute data to the various workstations. Ideally, use a dual-server configuration with redundant back-up systems and a tape back up. One server will work for the EPMS while the other acts as a back up and houses other software that integrates with your EPMS software. Plan to either store the tape back up off site on a weekly basis, store it electronically off site or write to a nonrewritable CD or DVD. Get a professional analysis of your current system and potential needs to determine your server and workstation recommendations.
Management Software Selection Checklist
here to access the Practice Management Software
Selection Checklist which is available as a PDF
download. (You will need Adobe Acrobat Reader to
view a PDF file. You can
download it here if you need.)
Software. Search for a platform that allows flexibility for each doctor in the practice to adapt the EPMS to their preferences. The platform should also integrate both administrative and clinical features for the practice. I've provided a comprehensive vendor list in "EPMS Vendors" on page 29.
Each EPMS program is slightly different, so compile a list of your practice needs. Access this article online and refer to the "Practice Management Software Selection Checklist" as you review the attributes of the various programs. Also included are a few helpful ideas in planning for the EPMS transition. After you've narrowed your list, contact the various vendors for a live demonstration.
What do I do with the paper?
So you've decided to go electronic, but what do you do with old and new records?
The old records. Take one of the following two actions:
1. Scan all existing medical record documents into your EPMS program. (This uses a great deal of storage capacity for information that you may never use.) Many EPMS vendors will have the ability to write a program to convert paper fields into the software program. Get a clear written explanation of the services that it will complete. Plan on this process taking as long as six months.
2. Scan or import (manually or digitally) any pertinent information in an existing file when the patient comes in. Doing so prevents excessive and unnecessary scanning for inactive patients. Important: Archive all paper files for at least seven years to meet legal requirements. Plan on it taking three to five years to complete the total conversion.
The new paper. The question that comes up post-conversion is, "What about the paper forms that you receive from outside sources such as referral letters, surgical reports or other diagnostics tests?" Scan them into your electronic files.
Your IT consultant can even discuss how to receive all of your faxes electronically and save scanning time. Why allow a "behind-the-times practice" to keep you one step behind?
The next step
As technology progresses, pen-based and voice recognition input will alter the doctor-patient encounter by increasing both eye contact and communication that's typically limited with paper charts. We'll be more productive, more efficient and give better quality patient service.
There have been estimates that 50% of medical facilities will have an EPMS by the end of 2006. An EPMS won't make your practice immediately more profitable, but it will continuously increase your profitability one patient at a time.
|1. Prepare yourself -- get a positive attitude
2. Assess where you are
a. Do you use computers now?
b. How do you use it/them?
i. Financial management
ii. Word processing
iii. Internet accessibility
iv. Marketing and patient demographics
v. Appointments or scheduling
c. Work flow analysis
i. Step-by-step functions of each area of your office
- Appointment scheduling protocol
- Clinical protocol
- Optical and contacts protocol
- Document management protocol
- Patient communications protocol
- Contract management
- Outcome analysis procedures
- Billing procedures
- Recall procedures
- Financial management protocols
3. Involve the key players in each area of the practice
b. Technical staff
d. Insurance and billing
4. Determine your needs (see checklist)
a. Hardware (upgrades?)
b. Software solutions
c. Integration issues
d. Networking needs
e. Workflow worries
f. Implementation ideas
i. Staff training needs
ii. Training timeline
g. Conversion timeline
5. Get a list of vendors (see "Electronic PMS Vendors")
a. Get a list of their clients
b. Contact those clients for multiple systems
c. Get a demo CD
d. Get an estimate
a. Overall final cost
b. Installation, upgrades and maintenance; time required for installation
i. Are the upgrades free?
ii. Who does the upgrades?
c. Resource assessment (Can you afford this?)
Dr. Morris is the director of Eye Consultants of Colorado, LLC, as well as Morris Education & Consulting Associates. He is a member of the American Optometric Association and is a Fellow of the American Academy of Optometry. You can reach him at
firstname.lastname@example.org or (302) 250-0376.
Optometric Management, Issue: December 2004