Show Me the System

Here's some advice to use when a vendor of practice management (PM) or electronic health records (EHR) software comes calling: Make them show you how the program works. And make them show you in person.

That's because you really need to see what's behind the screen before making a decision that could have an enormous impact on the success of your medical practice. I've seen software vendors who move so fast through their demo that you have no idea what's really going on. "Sure, we can do reports," they say, but then they gloss over how that's accomplished. Other vendors might offer to run a product demo as a Webcast or as part of a conference call. The screen shots may look great, but how will you know that's not all they are — screen shots?

You want a chance to kick the tires. And that means finding a vendor who's willing to come into your office, spend time answering all of your questions, and showing how the software can help make your office run more effectively.

Making a software vendor do more than a tap dance is the first step in ensuring that your new EHR and PM software performs the key tasks asked of it: capturing patient data, improving patient care, expediting billing and claims, and creating insight into how the business side of the practice operates. But choosing that ideal software package requires some thought.

Count the steps

During that office visit with the software vendor, one of the most important things is to gain some assurance that the transition to the software will not be too difficult to learn. These are powerful programs, and not everyone will pick up on their subtleties without significant training. But there are some things to look for during a sales pitch:

Does the patient come first? Increasingly, EHR products are entering the examining room. But poorly designed products force a physician to spend more time entering data than performing an examination. Ask for a demo of how data is captured for procedures common to the office, so you understand whether the software will be an actual help, or a hindrance.
Count the steps. For any objective — running A/R reports, tracking scheduling, retrieving patient charts — learn how many steps are required to achieve a particular objective. If an entirely new screen must be launched for each step, for instance, the software may be too complicated. You want the fewest steps possible to perform each task.
Is it a familiar interface? These days, Windows operating system and Microsoft Office from Redmond, Wash.-based Microsoft tend to be the de facto software standards. People are familiar with them, and products based on their interface are more likely to be adopted readily.

Adapts to a practice's practices

Remember, you want the EHR and PM software to work for you, rather than having you work for it. So it should fit with the way your practice handles its patients and does business.

For instance, many medical practices have specialties — cardiology, pediatrics, orthopedics, and more. In pediatrics, for instance, many EHR packages are geared solely toward the treatment of adults and can't be changed. So you might find that the software's diagnostic prompts ask about pregnancy or heart conditions, but have nothing to offer for common childhood problems such as earaches. So you want to be certain the software can be customized relatively easily to fit with your practice.

Our own practice is primarily focused on surgery, and we have our own procedures and protocols that aren't standard in many EHR packages. However, with a little help from the vendor, our main users have been able to customize it so that it now works well with our physicians.

Similarly, on the business side the software should fit easily with how billing managers and others do their jobs. It needs to help them easily track accounts receivables, add notes to claims and other documents reminding staff to check on a claim status or an insurance request, and provide alerts so that staff members are reminded of key dates such as when payments from insurers should arrive.

Most PM packages promise greater transparency into the business side of a medical practice, so ensure that's the case. You want to be able to readily customize reports, and quickly drill down to see what data is used to generate the numbers. If you want to compare how much time different insurers are taking to pay claims, you should be able to do that. Or, to create reports showing which patient groups have accounts receivables that are 30, 60 or 90 days out.

You also want to ask questions about the database that supports a system's reporting capabilities. You want a database that is robust, expandable, and secure.

Helps a practice run more efficiently

The reason to adopt EHR and PM software, of course, is in large part to help a practice operate more smoothly. So look for features such as:

Ease of tracking appointments. The scheduling module should easily supply information on a patients' scheduling history, including office visits and no-shows. You need a good record so that you can encourage regular no-shows to mend their ways, or ensure that patients have continuity of care should they miss an appointment.
Easy Web access. Doctors who are on call like features that allow them to access patient charts via the Internet, regardless of their location. So systems that work through the Web offer real advantages.
End-of-day procedures. Systems vary, but I like one that offers an end-of-day "batch" procedure. That allows me to open all the activities during the day — such as charges and procedures — and lock them down, so they can't be changed after the fact. That helps cut down on errors. Then, the next day, I can resume work on those activities and be confident there is continuity.

Offers good support

You'll be making a substantial investment when you buy a new EHR and PM system, so you want to know the vendor will support you after the purchase. Don't be shy — ask the sales team about the support staff's size and availability. I believe that a response to support issues should be forthcoming within 30 minutes. Our office once had a software package where it sometimes took up to a week for a call-back, which is, of course, completely unacceptable. You might even consider writing support guarantees and benchmarks into the contract when you make the purchase.

The right EHR and PM software can make a world of difference to a busy practice. Doctors have more accurate patient records and more easily follow a patient's progress. Charts are no longer misplaced — they're at everyone's fingertips. The business side needs fewer people for mundane tasks such as transcribing records, and can put them to work monitoring claims or on other high-value jobs. And chronic problems such as 90-day A/R accounts can largely be solved.

By taking some time to understand how practice software works, and how a vendor's offering fits with your practice, physicians and office business managers both will end up with a solution that fulfills the genuine promise of the digital medical office.

Bonnie Sellers is the practice manager for Orlando Pediatric Surgery, in Orlando, Fla.