July 10, 2012 in EHR Selection by support Team | Comments Off on How Aligned are your consultants to the Goals of Your Pediatric Practice?
A Pediatric practice needs to successfully work with both internal and external stakeholders to be successful. These stakeholders include employees and external vendors/companies and sometimes, consultants. There can be misalignment of the goals of each of these stakeholders with the goals of your Pediatric Practice. There are a number of questions to ask a consultant to insure they represent your best interests.
Some of these questions could include:
-Is the consultant recommending a product or service due to an alliance with their firm or due to quality of the product for your practice? For instance, a company that sells servers will have a bias to recommend server E.H.R. systems due to their revenue being made based on providing advice and maintaining servers. If a consultant speaks at an event sponsored by a Vendor, this might indicate that there is a bias for this vendor. A question to ask: Is the speaking engagement with a particular vendor due to the vendor providing them customers that they can charge their consultant service and do they speak equally at events for all vendors in the same state (not just the ones that send them practices)?
-Having a consultant choose an E.H.R. service, could cause a Pediatric office to obtain an ‘old’ technology product or a product that does not appropriately balance the revenue/cost needs of the practice with the desire for a consultant to provide a service. Some consultants might not have the technical expertise to make the ‘right’ decision for your Pediatric Practice. Recommend asking any “E.H.R. consultant” how long they have managed a practice as well as their experiences with optimizing revenue for a practice (there are many with great experiences and unfortunately some with none to minimal experience). Equal time should be spent discussing the revenue cycle/practice management as well as clinical aspects of the E.H.R.. Consulting advice should look to optimize revenue, minimize burden, cost and start-up time. The practice is ‘on the hook’ for long-term operation of a system/process and the receiving end of decisions made regarding a system.
-Does this consultant make more or less money if the practice identifies a solution that requires minimal work on their part? Why would a consultant that charges by the hour (whether paid for by the practice or the government) seek a system that reduces billable hours? The long-term operational burdens are the responsibilities of the practice not a consultant.
Exceptional consultants with a solid history should be able to balance the needs of their clients with the need to optimize their own billable hours. Great consultants know and understand the revenue cycle and provide hints on how to reduce administrative burdens of Pediatric Practices. With all the conflicting priorities and needs of a Pediatric Practice, it is important for a practice owner to select the ‘best’ consultants/advisors for their particular needs.
July 2, 2012 in EHR Selection by support Team | Comments Off on The Cost of Maintaining a Server in a Pediatric Practice
I enjoy speaking with customers, potential customers, vendors and suppliers to obtain feedback as well as perspective. Recently, I was made aware of the actual costs that a practice incurs for appropriately maintaining a server. The ‘old’ method of establishing Electronic Health Records in an office was to install and operate a server with an internal network. Although this is still an option today, there are many expenses such as initial and continued operating costs that cloud computing provides a better choice. The winners of practices that choose client-server E.H.R. Systems are server companies, software companies that supply software for client-server applications and technology/server consultants that maintain servers.
I continue to be made aware by physicians of the cost of operating a server. The range in cost really concerns me and surprises me. For example, I know of a one-physician practice that was spending over $700/month just on an IT consultant to maintain his servers/network. When the Internet was ‘dial-up’ there was not another option for a physician practice. Businesses of all sizes began moving from client-server applications to cloud-based applications for many reasons. Some of these reasons include: most up to date software, lower operating costs and easier establishment of additional computers/users.
Evaluate the total cost of the option when deciding to choose client-server vs. cloud computing. Here are some items to obtain cost ranges when comparing a cloud-based option to a client server option:
-Cost of the servers, network gear and estimates of how often this equipment needs to be replaced.
-Cost of installing the network
-Cost of maintaining optimal up time of the network as well as maintenance
-Cost of software for the server (initial and yearly cost).
Consider conducting some ‘basic’ research by calling a local IT consultant to obtain a price quote. Also remember that you or an office manager will need to be the project manager/coordinator of the people and vendors once the practice decides to choose either cloud-based application or a server-based application. With a cloud-based application, the practice will need to maintain an internet connection as well as a wireless network. If there is not a person in the office whom is comfortable setting up a wireless network, usually a lower cost group such as the Geek Squad can set this up for the office. With a client-server application, the office will need to purchase servers, network gear, software for servers (in addition to their E.H.R. software) as well as incur an expert to install the system and maintain the system. The practice will also need to install battery back-up and a maintenance plan with all the components. These are examples of some of the hardware maintenance costs of a server.
There are many articles on the economic benefits of cloud-computing. For instance, see the April 30, 2012 article in Forbes Magazine titled “Cloud Could Cut $12 Billion from US Government Annual Deficit”. The study quoted in this article states that the US Government could reduce the annual IT Spend from about $80 B to $68 B. The winner would be the cloud-computing companies while other groups would either lose their contract or have reduction in services. Do not under estimate the amount of lobbying, PR and Marketing that the groups impacted by this migration to cloud computing will exhibit. Remember, the practice is ‘on the hook’ for the short term and long-term cost of a decision of client-server vs. cloud computing (not an external consultant whom might have minimal to no experience optimizing revenue for a practice). Internet speeds continue to increase dramatically which further enhances the positive aspects of cloud-computing.
February 24, 2012 in EHR Selection by support Team | Comments Off on Meaningful Use Requirements for Your Pediatric Practice
The last few weeks there has been much discussion about the stage 2 meaningful use due to a recent press release from CMS: “The Proposed Rule for Stage 2 Meaningful Use has been Posted to the Federal Register; CMS Fact Sheet Provides Overview.” A Pediatric practice that is eligible for the incentive payments first needs to adopt a certified E.H.R. system (ONC-ATCB Certification). Then the practice starts with stage 1 meaningful use parameters. How difficult will stage 1 Meaningful Use be for your Pediatric Practice?
The answer to this question depends on how close the E.H.R. vendor was able to align the Meaningful Use requirements to the design of their system. If the system is multi-specialty or a ‘dated’ E.H.R. system or just a poor design, the disruption to meet meaningful use might be so great that the practice should either not pursue the additional incentive money or switch to an E.H.R. System that is less disruptive. Let’s look at the parameters for Stage 1 Meaningful Use. The parameters for meaningful use stage 1 include:
• Problem List
• Active Medications
• Active Medication Allergies
• Patient-specific Resources
• Information Updates
• Medication CPOE
• Permissible Prescriptions
• Vital Signs
• Smoking Status
• Electronic Copy
• Clinical Summaries
• Appointment Reminders
• Transfer Medications
• Referral/Transfer Records
How does a practice meet or exceed the benchmarks? Some suggestions include leveraging the dashboard to monitor where the practice is exceeding the benchmarks and where there are gaps. During a demo of a Pediatric E.H.R. system, request the vendor to review the meaningful use dashboard/report. This should be a simple to use tool that color codes the results (green, yellow, red) so a reviewer can quickly see the strengths and areas to correct. The report should be able to be used by Identifying where in your workflow there are gaps. For example, maybe the practice is not capturing some of the key demographics such as race, ethnic group, smoking status while the patient checks in to the office. This is very easy to correct. Many of the benchmarks are fairly easy to meet as long as the system is connected and the providers are using the connections such as sending electronic prescriptions, sending/receiving laboratory orders/results to Lab Corp or Quest, sending data to the state immunization registry. Your Pediatric E.H.R. vendor should be able to provide some quick tips to your practice that will make it relatively simple to meet the meaningful use goals.
February 10, 2012 in EHR Selection by support Team | Comments Off on Importance of Appropriate Documentation of Different Sick and Well Visits in a Pediatric Office
Remember during Pediatric Residency when you had more time to document Visits in the clinic? As a Pediatrician in training, you were probably not seeing 25+ patients per day. This slower pace and multiple residents in the clinic allowed time to write and write and write (usually there were paper charts in previous residency programs). Once in clinical practice, many Pediatricians were only able to document a sentence or some key words for the visit due to the time pressures of Practicing Primary care Pediatrics. Although, in most cases, the Pediatrician had a total well visit, the clinical paper chart did not completely reflect what was done during the visit. This level of charting is not optimal for continuity of care as well as documentation related to coding and billing.
A visit at a Pediatric office has a much different look and feel than the visit at a plastic surgeons’ office. When an Electronic Health Record system is designed for all specialties, the system usually misses many of the day-to-day details of a particular specialty (if you are in a Multi-specialty group, you might not have a choice). Even if a general E.H.R. system maintains all the content of a One Physician Specialty, the E.H.R. system has many extra windows/screens/options due to being designed for every specialty. A ‘universal’ design usually causes hours of extra charting time and in many cases misses pertinent information found in a single specialty Electronic Health Record system.
Clinical Templates provide a list of options for a visit (e.g. Asthma Template) that can also serve as reminders of options for treatment. Template design is also important for ease of documentation. A template that looks like MS Excel with boxes and many pop-ups is generally much more different to see, use and document than a template with appropriate ‘white space’ that looks more like paper. Differences in design also might provide an indicator of how up-to-date the vendor is on their User Interface.
Here are some areas that all Pediatric-Specific E.H.R. systems should contain:
• Layout and design of system based on today’s Pediatric office. This means easy to use and see screens, different views of the system depending on role of individual in the practice (Front Desk, Medical Assistant, Nurse, Practice Administration, Billing, Physician, other Providers).
• Templates based on content similar to either bright futures or Denver development.
• Growth charts based on today’s recommended standard per the AAP/CDC.
• Listing by family, linking siblings, ability to copy medical and social history from siblings
• Communication tools such as e-mail reminders, voice message reminders and announcements.
• Patient Portal.
• Link of Back-end Medical Billing to Front Desk team to communicate/flag charts that have a balance to be collected on next visit.
• Ability to link to Vaccine Exchanges, Quest, Lab Corp and Health Exchanges.
Some other questions to consider: Was and does the system continue to be developed via a Pediatric Office? Is this office similar to your office in operations (for instance, do they accept Medical Assistance and have integration with Vaccine for Children)?