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Successful practice software selection

By James A. Kuly &
Carla J. Krasnick

Six steps for successful software selection.

Selecting new software for your medical practice can be a very intimidating task. We’ve all heard stories of how poor decisions left some practices in chaos with unhappy patients, frustrated staff and angry physicians, not to mention wasted time, effort and money. Here are the six steps we’ve discovered for successfully selecting the right software for your medical practice.
Organize for Success
Successful software selection requires a team effort and effective leadership. It is vital to the success of the project that accountability and “ownership” of the software be placed where it belongs—with the people who will ultimately be using it. Therefore, it is primarily the end-users, not practice management, who must do the real work of defining specific requirements and selecting the software that meets those requirements. It is the end-users who must determine the objectives of the project and make the tough decisions and compromises that are often required. Only then will you eliminate most objections and “I told you so’s.”
The software selection team should be made up of end-users drawn from all areas of the practice. There are only two requirements to keep in mind when choosing selection team members. The first is that they be capable of effectively representing their departments. In fact, they should be the best people you can find, not just those that can be spared. It’s better to have a few competent people on a selection team than a “cast of thousands.” And second, they must be available when needed for the project if the software is to be implemented effectively and on time That means practice management must do whatever is necessary to make team members available, focused and capable.
Effective leadership of the software selection team is also crucial. Consensus decision making is required during the entire selection process. The team leader must be a facilitator, not a dictator. The leader should be someone with the ability to listen, question and find the common ground. This person may or may not be a physician or the practice manager.
It is a good idea to provide general computer training to all team members before starting the selection process. The computer industry is changing rapidly. It’s imperative that the team have at least a basic understanding of issues such as operating systems, processing speed, memory, hard drive capacity, networking, etc. There are a number of training opportunities available.
Focus Your Efforts
After you’ve created an effective structure for your project and educated the people associated with the project, it is necessary to focus the efforts of your software selection team. Developing a “focus” requires a combined top-down and bottom-up approach.
While there are in fact more technical issues to deal with than ever before, practice software selection is still more of a business and political task than a technical one. To set the stage for a successful selection, the issues of practice objectives, goals, needs and plans must first be addressed. To do this effectively, the team must review the practice’s business plan and determine the role that both information and technology will play in the future success of the practice. This research should provide an estimate of the expected growth of the practice and note any changes anticipated in work done by the practice that may affect software selection. It should also include such things as expected increases in managed care contracts, new service offerings planned or additional reporting requirements. Finally, the team should establish project constraints such as cost limits and time frames.
The result, a two to three page document we call System Expectations and Objectives, will help keep the selection team focused as it wades through the swamp of software functions, features and options. It describes, in general terms, the expectations and objectives of everyone who will use the system or be affected by the system.
Additional project focus can be achieved with the creation of a project plan. This plan is a list of all activities you and your team believe are required in the entire selection process, from start to finish. It should contain more detail on activities that need to be accomplished in the next month or two and less detail for activities farther out in the future. The plan should list activities and indicate the amount of time required to complete each activity, the relationship of one activity to another and the person(s) responsible for accomplishing the activity.
Optimize Before You Automate
Before you get involved with what software vendors offer or don’t offer, get your practice in order. Many software selection projects go awry because of internal practice problems, not software vendor problems.
Because medical practices are “information-based” businesses, productivity depends on how well information is handled internally. Unfortunately, just increasing technology will not necessarily improve your practice’s productivity. In fact, the introduction of new technology, especially one that requires everyone to master new skills and procedures, will tend to decrease productivity for a time. Therefore, before finalizing your information requirements, take some time to improve the way work is done in your practice by determining the work processes affected by new software and identifying improvement opportunities within those processes. This is also the time to clean out all those old, unpaid receivables.
Define Your Requirements
Start the definition step by checking the overall capability and qualifications of the eight to ten vendors who appear to offer software that meets your practice’s needs. Do some basic research on software and vendors using these resources as well as information from medical societies, colleagues, journal articles, the Internet, etc. Create a simple request for information questionnaire to send each prospective vendor to obtain additional information on software features and functionality as well as hardware requirements. It is also a good idea to determine such things as whether the vendor is the software developer or a dealer, how long they’ve been in business, and how many installations they completed within the past 12 months.
The next task is to define your specific technical software and system functions, features, and requirements. Define your requirements by developing a series of statements for each functional area by completing the sentence, “Our new information system must (should)…” Use brief statements that start with a verb to describe your needs. For example: ??

?Our new information system must…

• Allow several people to book appointments simultaneously for five providers as well as various rooms and equipment.
• Show real-time aged balance information on each patient and insurance company.
• Handle a minimum of 3 insurance carriers per patient.”
The final task in this step is to create and distribute a request for proposal (RFP) to vendors. The RFP is used to communicate your requirements, establish the basis for software evaluation and selection, and to structure the relationship with the vendor. Send the RFP to the three to five vendors who you determined meet your capability and qualifications requirements.
Select the System
Start the selection step by arranging for a demonstration of the software at your office. Make sure that the software you see is the standard software provided by the vendor, not a special or test version. Ask questions of the salesperson based on your system expectations and objectives and your system requirements definition. Test the software to determine how easy it is do perform specific tasks such as add a new patient, make an appointment, create a report, add patient charges, etc. If needed, arrange for a demo copy to be left at the practice for a period of time.
Each team member must take time to thoroughly study all software and hardware literature and all proposals provided by the vendors. When reviewing this material, don’t get caught in a “functions and features” trap. Comparing a large number of features offered by several software packages can be a bewildering feat. It often results in ignoring important qualification criteria. The best way to analyze each proposal is to compare it to your original system requirements definition and expectations & objectives. Never accept a vendor’s claim that the software “does everything” and that you don’t have to waste time comparing its features to your requirements.
The best and quickest way to check out a vendor and his software is to talk to customers. Not just the hand-picked references given by the vendor, but your own independent contacts that you know will be frank with you. Visit reference sites and users when possible to see for yourself how other practices actually use the software, how well it works and the kinds of glitches that exist. It is also important to learn how easy or difficult it is to work with the vendor, problem areas encountered in hardware or software installation and customization, and vendor responsiveness to problems after installation.
The final software and hardware selection must be a decision reached by the consensus of the entire selection team. It is more important to get key players to agree on a specific course of action rather than make the “perfect” software decision. When selecting software remember to be flexible. More than likely, no package will meet all of your requirements. Be prepared to give up something to get something you need even more. Also, it is important to understand that medical software today is in a state of transition. The older DOS and UNIX systems are gradually being moved to Windows. While the new Windows software offers greater ease-of-use characteristics and better integration capability with other software, they typically don’t have all the features or functionality of the older systems.
The final activity in this step is to negotiate with the vendor of choice and create a contract. It’s important to get everything in writing and not to accept oral promises. The contract is the key to the formal relationship with the vendor. Seek professional help during contract negotiations. A contract is especially important when anything other than the standard software package is involved or when enhancements, customization or other services are required.
Implement the System
The selection process is not complete until the software is installed, tested and up-and-running. The final step in successful medical software selection, therefore, is to install the system. The software selection team should expand the project plan to include the installation of hardware and software, software customization, data conversion, training and testing. These activities are based on the specific software/hardware that was chosen. Work closely with the software and hardware vendors. Take their advice on the best, most effective way to implement their system but remain in charge of the process.
Major changes taking place in the health care industry require medical practices to have better, more advanced information systems. Unfortunately, both medical practice software and computer hardware have become much more complicated in recent years. Replacing practice software and computer hardware is too expensive, and its selection too important to be left to chance. Because the long-term success of your practice is at stake, it is essential that these six steps be followed to ensure an orderly, thorough and successful software selection process.

James A. Kuly, BSME, MBA, is president of Visioneering, a technology and productivity consulting firm located in Springfield, PA. Carla J. Krasnick, MBA, MSN, is vice president of the Thayer Group, Inc. a health care management consulting firm located in Swarthmore, PA.

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