information technology Articles - Medical Practice Trends

IT Services for Your Practice – In-House or Outsource?

April 4, 2012 By Peter Polack 1 Comment

Previously I wrote about outsourcing your IT services support as well as how to hire an IT director. But one question that I am commonly asked is, “How do I decide whether to keep IT services in-house or whether they should be out-sourced?”

Electronic medical records systems have become an integral part of the practice of medicine and having someone with IT expertise in your corner is no longer a luxury but a necessity. But for most medical practices, this decision is strictly a monetary one. Still, there are more issues to consider than just budget.

Why you should have IT in-house

You are completely clueless about technology and need someone at your beck and call
You want someone with particular expertise in your specific EMR software
You want someone who has specific knowledge of your medical specialty
The physicians in your practice want their daily IT needs handled on an expeditious basis
Your practice can afford to pay a market salary and benefits for a full-time IT person

Why you should outsource IT services

You cannot afford to hire a full-time IT person
You have a small practice and you consider yourself ‘tech-savvy’
You are using a web-based EMR system and have a minimal IT infrastructure
You need or require 24/7 support
The complexity of your practice demands redundancy in the support services
There is a large volume of basic, mundane tasks that have to be handled on a daily basis

Why you should do both

Another option to consider: the hybrid model. Whether you decide to out-source IT services or bring in your own full-time person, a concern in either case is the transfer of knowledge. If you have a full-time IT employee, that person’s fund of knowledge – about your practice, about your EMR system, about your processes – walks out the door with him or her. Even if they are meticulous about documenting all of their processes, this can still be a devastating loss. While this risk can be lessened with an out-source firm, there is still the potential for loss if their services are terminated and you have to hire another firm.

By having both, you could build in enough redundancies that your practice can be protected in the event of a staffing change. The out-sourcing can provide around-the-clock monitoring of your IT infrastructure and handle basic, day-to-day operational issues such as computer trouble-shooting, password resets, and printer repairs. Your IT employee can oversee the out-sourcing firm while at the same time looking out for the best interests of the practice, providing physicians with prompt, personalized attention, and concentrating his or her efforts on more specialized work such as EMR templates, Meaningful Use issues, and the like.

Deciding to Go Paperless

April 3, 2012 By Peter Polack Leave a Comment

Most medical offices today are using an electronic practice management (EPM) system. This software is a far cry from its paper-based ancestors, the appointment and ledger books. The EPM market has expanded over the last twenty or so years to include a variety of products on several platforms. And increasingly we are witnessing the digital revolution in electronic medical records (EMR). Unfortunately, while many such systems have been implemented, to this day a truly paperless office seems like a pipe-dream.

For subjective-objective-assessment-plan (SOAP)-based patient care, the first generation of electronic medical records (EMR) systems worked well. Medical specialties which are primarily text-oriented tended to fare better, as compared to graphic-oriented specialties such as ophthalmology. At our practice we have used an EPM since 1983. But although this software met our needs for billing and scheduling, we were still accumulating stacks of paper records which required an increasing expense just to store the paper.

As we considered a change to an electronic medical records system, our practice compared the expected costs for paper records storage to the costs of converting to a new system. We fully understood that we’d have to become more efficient to make the transition cost-effective.

System Implementation Costs include:

Infrastructure
Consulting
Software
Hardware
Tech Support

We also included the cost of additional work-hours which will be spent training people on the new system, along with data entry. In most cases a practice uses both the old and new systems concurrently until the entire conversion is complete. In the meantime, there could be some redundant tasks.

The primary factor in our decision to switch to EMR was based on the need to reduce the growing mass of paper we were storing. And it didn’t hurt to hopefully ride the wave of financial incentives from the government for EMR implementation. Meanwhile, there was the opportunity to proactively implement new HIPAA privacy and security guidelines in a way that would work best in our practice.

System Benefits Include:

Improved Communication
Better Efficiency
Improved Compliance
Enhanced Documentation
Justifiable Coding
Improved Integration

At our practice, the business choice came down to the belief that we could recoup our investment in approximately five years. This calculation was based on the savings of projected storage space costs, along with reduced needs for printing expenses and services. The journal Health Affairs found that the average primary-care practice recovered its costs in 30 months.

It is more difficult to measure the value of change to job efficiency and changes in staffing patterns, but we are monitoring these factors to accurately measure returns on our investment. Some studies have shown reductions in medical records staffing of 0.25 – 0.5 full-time equivalents (FTEs) as well as significant savings in dictation costs.

The overall trend seems to be toward a world where EMR is the norm. Insurance companies and government are placing more pressure on health-care providers to standardize medical records, and EMR could soon become obligatory. Costs are dropping as more businesses adopt the technology; soon even the smallest practices may find it cost-effective to ‘go paperless’.

[Update 2012] We now have just over 3 years’ experience with our EMR system. We started with a gradual rollout and now see 100% of patients on EMR. Even our original naysayers are happy since they each have their own templates and can’t imagine going back to paper charts. Is it perfect? Are we hiccupfree? No. But the efficiency gains we have seen are real and practice wide. If you hear about a practice that laments their conversion to EMR, they have probably failed along the way in their implementation process – it’s usually not the fault of the EMR system but a people or planning problem.

Medical Practice Trends Podcast 11: Five Best Practices for EHR Implementation

May 31, 2011 By Peter Polack Leave a Comment

MPT Podcast 11 – Five Best Practices for EHR Implementation, with guest Chris Mertens, VP of the Personal Systems Group for Hewlett-Packard.

This Issue:

Why you should take a good look at your processes before purchasing an EMR system
How to minimize lost productivity
Why installation of an EMR system is not the final step in the implementation process

Medical Practice Trends Podcast 9: The Challenges of Integrating a New Technology into the Medical Practice

May 17, 2011 By Peter Polack 1 Comment

MPT Podcast 9 – The Challenges of Integrating a New Technology into the Medical Practice, with guest Chris Mertens, VP of the Personal Systems Group for Hewlett-Packard.

This Issue:

Why healthcare providers are skeptical of implementing EHR despite its reported benefits
What are some other concerns physicians have, such as cost or loss of productivity?
What are some issues related to the quality of patient care?

How to Hire an IT Manager – Part 2 – Your Action Plan

November 11, 2010 By Peter Polack 2 Comments

In Part 1, I discussed some of the challenges we face in hiring IT (information technology) personnel, a role which is becoming an increasingly common part of the medical practice. One of the major challenges is trying to validate the skillsets and credentials of a prospect. In Part 2, I present an action plan for finding a well-skilled IT employee who will be a good fit in your organization and help keep your network (or EMR system) up and running.

Create a job description. Do you already have a good idea what this person will do for you? Great. If you don’t, get some assistance. You can either ask the Director of IT for a practice in your area or the local hospital to help you come up with a very specific job description. This should include the certifications required for the job (see Part 1) and the expected hours as well as duties – for some people, squeezing through crawlspaces to run network wire is a deal-breaker. You’ll also want to ask your expert what the expected range of salaries would be in your particular market, given your specified skillsets. Even in this economy, people in the IT industry with experience can command some decent pay.
Post the ad. Do you live in a small town? Then you might want to think locally. It might be difficult to recruit someone away from a major metropolitan area and your salary offer might be less than they are accustomed to. Apart from placing the ad in your local newspaper, you should post it on a major job listing site like Monster.com. One advantage of using a site like that is that the resumes are stored in an electronic format which makes going through the information much easier (see number 3). It also makes it easier for potential candidates to search for the appropriate job.
Start vetting the candidates. Rather than using a head-hunter (more on this later) we opted to go with a consultant, Mike Sellers of CVPSite.com, a credential-verification company. They offer a free service to employers that verifies the credentials claimed on the resume of a potential IT candidate (they charge the applicants a fee for going through their certification process, thereby giving them their seal of approval and making them more attractive a prospect). Based on our job description and some other specific criteria, Mike ran the resumes through their proprietary system to rate the candidates. He then took the top sixteen of these and interviewed them by phone in order to ascertain whether their listed qualifications were genuine – he could usually tell after just a few questions if the applicant truly had the experience and credentials that they listed. In one instance, the candidate gave up early and readily admitted that his credentials were bogus. When the process was complete, we were handed a spreadsheet with all of the applicants and their ratings on a multitude of specific criteria, ranked top to bottom, with the finalists clearly identified.
Considering using predictive testing. Recent research is showing that personality or IQ tests are less predictive of an employee’s success in a particular job than what is known as conative testing. This describes a person’s modus operandi or M.O. – how are they likely to act in a particular situation. The most well-known of these is called Kolbe Testing. The practice administrator and/or direct supervisor of the applicant take one test to determine their own Kolbe ‘profile’, then take another test to determine the profile of the ideal employee. Last, the job applicants take another Kolbe test to see if they would be a good ‘fit’ for the practice. Obviously this should be just part of your overall assessment (we have just started using this tool, so the jury is still out). Another type of assessment tool to consider is Predictive Index testing from PI Worldwide .
Final interviews. After going through the process above, you should have four to six finalists for your face-to-face interviews. Since your expert has already vetted their credentials and assessed their technical skillsets, your finalists are all on a level playing field. Now all you have to do is subject them to the same rigorous evaluation process as you do for any other (highly-compensated) employees and make sure that you feel that person is a good fit for your practice. You know they are highly skilled, but do they also have good people skills? It is critical for the person in this position to act as a liaison between the technical world and the real world. You might also want to consider involving a subordinate in the evaluation process – a person who works in the same technical field can have valuable input.

Why didn’t we just retain the services of a head-hunter like we do when hiring a medical associate? Like a listing agent in real estate, the head-hunter doesn’t necessarily represent the buyer – in this case, our practice. Their main job is to place their clients, the job applicant, i.e. the ‘seller’. Sure, their reputation is at stake and they want to make sure you are satisfied so they can count on you for more business. But they will make their fee, regardless of who is placed in your practice. And although most reputable head-hunter firms have some sort of guarantee if the prospect doesn’t work out, this is not something we wanted to waste a lot of time on. For this reason, and for reasons I listed above, we decided to go with a ‘broker’: an expert who performs a formal candidate analysis.

How to Hire an IT Manager – Part 1

October 21, 2010 By Peter Polack 5 Comments

About 8 years ago or so, our practice decided to move from paper records to electronic records. The decision was helped along by the fact that we were literally running out of space for our paper charts. I had been looking at electronic medical records systems (EMRs) for years prior to this but could not justify the cost to my partners – apart from the “gee-whiz” factor – until we were up against the wall, so to speak. Our administrator had previously worked in a non-profit where he met an individual who was doing contract information technology (IT) work and recommended we hire him to help us achieve our goal of having a paperless practice.

Fast forward to today. We implemented EMR in our practice at the end of 2008 and performed a gradual rollout to minimize the impact on the clinics and thus the bottom line. We were able to start adding new patients with no significant effect on our efficiency and have subsequently added other patient types to the mix. Our IT Director, who spear-headed this project, commuted from almost an hour away the eight years that he was with us; alas, this eventually took its toll and he decided to leave us and take a position closer to home.

Since we are approaching the deadline for meaningful use of EMR, we felt this was a critical position to fill – and soon. In a practice our size, the IT Director is the next most important person after the Administrator and the Chief Operating Office or Assistant Administrator. And since we were already running on EMR, though not yet at 100%, time was of the essence. Fortunately, we had two other IT employees who could keep things running during our search.

As physicians and medical practice administrators we feel pretty comfortable with the thought of having to recruit, interview, and hire a new medical associate. There are professional head-hunter firms that can throw resumes your way and even help vet potential candidates. We know what questions to ask, what skills are important, and we know how to tell whether or not an applicant is the real deal. The problem with trying to hire an IT director is that we don’t know what questions to ask, what skills are important, and we probably can’t easily identify someone passing himself off as an expert when he’s not (this position was open to applicants from both genders, though 99% happened to be male). By the way, if you happen to be in IT and looking for a job, here is a good article on the 5 Tips for Becoming a Successful IT Manager.

Our next step was to consult with our extended family of experts: my brother, who oversaw an IT department, and the spouse of one of our partners, who works for a major software company. We all decided that any potential candidates would need to be vetted by someone who was in the IT industry even before our experienced management team performed any interviews. It is difficult to verify the credentials of people in this field – MNS, ACE, ACTP, CCNA, CCNP, MCP, CNX, LPIC, LCSE, OCP, WAN-ACE, CSTE, to name but a very few [if you really want to see your head spin, here is a more complete list of IT certifications ]. After our conference call, we had our plan of action.

Next: How to Hire an IT Manager – Part 2

The Benefits of Having an Office Computer Network

October 8, 2009 By Peter Polack 3 Comments

There are many benefits associated with having a computer office network, regardless of whether you are ready to implement electronic medical records (EMR) or not. For example, what may begin as a helpful suggestion from an employee can blossom into a practice-wide tool which can improve overall productivity.

grid network.jpg ProtoQue is a program which was developed in response to a problem we were having with our phone triage: we noticed that many patients were not called back in a timely fashion. This program, which is web-based, lets operators register calls automatically. The patient is then subsequently passed off from there to either medical records or a medical assistant. This program manages the ‘chain of custody’ so that the patient doesn’t slip through the cracks. The issue remains open until the problem is resolved. Every time a patient receives a return phone call, a time stamp is created, so our attempts to contact them are documented. The supervisors can use this application to monitor information flow, delegating calls to additional staff if the team falls behind, regardless of where they are located. We no longer have patients waiting until the next day to have their concerns addressed by our staff. Even though our EMR system, like most, has a messaging feature, we still find this program to be more robust and have continued to use it for over three years.

In addition to the phone triage program, we have designed some in-house programs that help us manage specific tasks, and which would not be possible without our computer network:

The first helps calculate our eyeglass prescription capture rate, which is broken down by location and individual doctor.
We also have an optical lab tracker program, which tracks jobs in real time, so an optician can tell a patient precisely when their order will be ready.
Another custom application completes work-orders, and is located on a network that is accessible by IT, Human Resources, and Facilities. If supplies are needed, or a piece of equipment is damaged, an employee can complete a work-order and send it on to the right person. This facilitates full accountability while the chain of custody among the departments is being managed.
Our Human Resources staff is working on an application that will let new employees enroll using our own electronic interface.
A new PQRI Tools program which resulted in a significant federal incentive bonus. It attaches to the practice management system and identifies missed reporting before billing.

If you have any comments, please post them here. You can also post any questions you might have about some of our software tools.

Healthcare IT Market Poised for Growth

August 9, 2009 By Peter Polack Leave a Comment

According to an article by Lou Agosta in B-Eye-Network.com, 80% of healthcare is delivered by medical practices consisting of only 1 to 5 doctors. And most big players in the EMR software system arena are marketing to larger clinics and multi-specialty institutions.

Even existing and proposed open-source systems such as OpenVistA still require significant investments in infrastructure on the part of the clients. And the government seems to be pushing for more open-source solutions, catching the attention of proprietary vendors like GE Healthcare, who may be offering some less-expensive options.

Still, there is a a lot of potential for EMR vendors who can target small medical practices, possibly with the SaaS (software as a service) or ASP (application-service provider) models.

Click here to read the entire article.

Semantic Web – A New Model for Healthcare IT?

July 29, 2009 By Peter Polack Leave a Comment

There is a very interesting blog post by Steve Brown that gives us a novel way of approaching the massive challenge that is healthcare reform. While politicians and pundits are arguing about how to spend stimulus bill money, nobody is thinking about how to improve the dissemination of information. This, after all, is the holy grail of EMRs (electronic medical records). Not just the reduction of medical errors but also the great benefits of EHR (electronic health records) which promise greater efficiencies in the delivery of medicine.