From a technology standpoint, 30 years is analogous to a geologic age. Even with regular upgrades, older systems — often running on a first-generation Unix platform — simply cannot keep pace with today’s data handling needs. Yet when Physicians Practice surveyed physicians on their technology usage last year, we discovered that practice management systems (PMS) seem to be on many offices’ IT back burners. Nearly three in 10 practices told us that their PMS is at least five years old, while 10 percent bought their systems more than a decade ago.
Is this because practices are so happy with their systems they just can’t bear to part with them? Hardly. Only one-third of the 365 responding practices report being satisfied with their PMS; six in 10 wish their system could do more than it does. (See the full results of our 2006 Technology Survey.)
So what gives? Why is this piece of medical technology lagging behind its glitzier cousin, the EMR? If you’ve waited too long to upgrade this important administrative tool, read on to discover the benefits and mechanics of doing so.
It is broke, but don’t fix it
Bristol Park Medical Group in Santa Ana, Calif., upgraded its PMS many times, but the practice ultimately found it needed something more functional and modern. It went with a system that uses the state-of-the-art in PMS technology platforms: a relational database management system, or RDBMS, and its communication partner, structured query language, or SQL.
But if your practice operates at a more modest level of technology-know-how, fear not. An RDBMS/SQL implementation can hide its geeky guts behind a socially adept Windows-based facade and still offer an intuitive and comprehensive solution to your practice’s administrative needs, such as flexible scheduling, smooth and effective billing and claims management, and customizable “practice adviser” system start-up screens that greet you every morning with a useful, near-real-time snapshot of your practice’s administrative health.
Do your cranial muscles ache from keeping an almost constant fisheye on your front-desk workers, because otherwise they would shirk posting copays during patient processing? With an upgraded system, there’s help for you with nanny-type “auto-flow” tools, a series of steps that users must follow — mandated by you.
Modern practice management software also has advantages in terms of easing user interface, starting with graphics. First designed when character-based, low-resolution monochrome monitors were the norm, legacy systems are easy to spot with their green or amber screens, chunky ASCII-standard text, and quarter-inch-high blinking cursors. Today, high-resolution LCD flat screens grace many administrators’ desks. Through these monitors, the software can draw upon millions of color choices to simplify practice management processes. For example, one color can be assigned to a specific physician or procedure. Then when your front-desk person schedules a patient appointment — often a hectic and distracted affair, especially over the phone with a worried parent — the colors communicate meaningful information back to her, as her brain can process a picture much more quickly than text. Hmm, what’s that pink doing there? We don’t do well-child visits on Friday afternoons.
Talkin’ ’bout my generation
Beyond the aesthetics, an upgraded user interface offers functionality far beyond even the most well-implemented old-school system, and it’s familiar to newly hired support staff, who tend to be 20-somethings — a generation unfamiliar with life before Bill Gates. This greatly facilitates training. “We can teach them the philosophy of their jobs as opposed to the navigation of the system,” says Darlene Jenkins, practice administrator for Obstetric & Gynecologic Affiliates of Katy, located 30 miles west of Houston. “They immediately know ‘drop-down.’ Now I can talk about the art of scheduling and not ‘backslash-R-C-L.’”
Jenkins is spelling out a typically cryptic Unix-style command used by her office’s previous practice management system, Medical Manager. Absorbing the “language” took awhile, but once users had mastered it, they became über-efficient with system navigation. Jenkins notes that this hard-won veteran expertise can actually work against an otherwise smooth practice management transition.
Blair agrees. He says that although replacing an old system makes for a vast improvement in functionality and data quality, it also means that “you lose a lot of experience with the senior billers. Tips and tricks get lost, which affects work flow. In the billing department, they lost several hundred years of accumulated training.”
Still, if you upgrade your practice’s PMS, you can count on an overall improvement in staff productivity and, by extension, increased patient satisfaction, thanks to more flexible scheduling and easy data access.
You can also expect faster, more accurate claims processing with a modern PMS — down from a typical 30 to 60 days for paper submissions to 10 to 14 days electronically. “Often we get paid within the same month,” says Jenkins. “Or at least we know how bad it is that much sooner.” Another major area of concern addressed by upgrading is that of standardized data regulations. HIPAA compels practices to achieve such compliance or else suffer the consequence of claims rejected because of missing or incorrect data. Practice management vendors are not required to make your legacy system HIPAA-compliant. Also, there are other encroaching data-standardization issues to bear in mind, including the mandatory, unique National Provider Identifier numbers, which must be in place by May 23, 2007, for all providers who use HIPAA-standard electronic transmissions.
PMS/EMR interfacing
Finally, with EMR adoption on the rise nationally, you’ll want a practice management system that interacts well with your EMR because the data between these two applications overlap. Ideally, you should stay with the same vendor for both applications, suggest veteran upgraders, “because otherwise you can really get burned,” says Jenkins.
Bristol Park’s Pat Dolphin completely agrees. “That was an absolute factor [for vendor selection] for us,” she says. Blair notes that initially, “We felt it was a little bit too much risk to put everything into one system. … Lo and behold, we ended up selecting a system that was integrated, and got the best of both worlds.”
Besides, says Jenkins, upgrading your PMS is simply easier to do than implementing an EMR. “The PM upgrade wasn’t painful; EHR was painful,” she says. Why? Because physicians are generally less involved in ongoing practice management tasks than they are with those carried out via an EMR; thus, their impact carries less weight.
And why waste time cobbling a connection between your spiffy new EMR and old-school practice management software anyway? Previously, these two systems worked off two databases; now, just one elegant, flexible database serves both entities if both systems come from the same vendor — although some EMR-less vendors will tell you how easy it is to share data across platforms. Be wary of this, especially since there are as yet no set national standards for EMR data records.
