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Selecting the right computer system

By Sherry Migliore, MPA

The process of selecting a computer system is a critical decision for a medical practice, perhaps one of the most important operational decisions a physician can make. The implications of this decision extend far beyond the purchase price of the software and hardware. There are a wide variety of systems on the market, and it is important to identify the features you are looking for before purchasing a system.

Before you begin, be sure to answer the following questions:

What do I want the system to do? Some physicians utilize computer systems for basic patient registration and billing purposes only. These are the most basic functions a practice management system performs. Others practices want to utilize automated patient scheduling as well. Many physicians are becoming interested in implementing electronic medical records systems in their offices. Some other computer applications of interest might include managed care referral tracking, word processing, Internet interface, report writing, disease management and quality improvement. It is important for physicians to identify their future goals when evaluating computer system needs.

Who will utilize the system and what are their needs? It is important to obtain input from the staff who will be utilizing the system. What are the features of your current system or systems you have used previously that you like or dislike? The number of office locations you have and the number of terminals needed to process patients in an efficient manner are also important considerations. A practice with one physician or one office location will have very different needs from that of a large group with various specialties and several locations.

The practice should develop an RFP (request for proposal) including the needs identified above. Potential vendors should be those that specialize in health care practice management. It is also preferable to purchase hardware and software from the same vendor to eliminate “finger-pointing” when and if problems arise with the system. Vendor stability and commitment are critical issues. Be sure you know how long the company has been in business and how long they have been providing the product. This information can be researched on the Internet. Potential vendors should also be requested to supply references. At least three of these references should be contacted.

Vendors should also be requested to include in their proposals how they anticipate implementing the project in your practice, a tentative installation schedule and expected costs. Be sure that clearly identified costs are provided for all of the following:

Hardware. Each piece of hardware should be priced separately, including terminals, modems, printers, cabling, etc.

Software. Be sure you understand the process and expense for software upgrades.

Training and setup. Ensure that you know the extent and cost of initial training for using the system. A hidden cost with respect to training is the reduced productivity of your staff while they are learning to utilize the new system.

Data conversion. If you currently have a computer system, what is the cost to electronically convert the current data to be usable in the new system? It is important to note that not all systems have the capability for electronic conversion. Data conversion generally includes what is often referred to the patient’s “upper demographic” data (name, address and insurance company). Data conversion generally does not refer to entry of line item balances, scheduled appointments, etc. Some vendors quote a fixed price to convert all of the practice’s patient data. Others may quote a price per patient record. Some vendors also offer manual data entry of patient demographics, normally quoted on a per patient basis. The price for this service is normally around $1.00 per patient record.

Maintenance. What are the costs to maintain the hardware and software on an ongoing basis? Many vendors include a free limited time warranty on hardware and software. At one time, it was common for this warranty to be for a full year. Most recently, however, vendors are providing this free warranty for a shorter period of time, usually 3-6 months. The practice should be sure to determine if the hardware maintenance will be performed on or off-site. Extension of both the hardware and software warranties can often be negotiated with the vendor.

Supplies. What are the anticipated expenses for items such as printer cartridges, back-up tapes and other supplies needed to operate the system? Many vendors provide a limited amount of “free” supplies with the purchase of a system to get the practice started. These supplies often include items such as printer paper and ribbons, back-up tapes and HCFA 1500 forms.

Practice management systems offer interesting and useful features and options These include:

Electronic medical records (EMR). This technology is fast becoming a preferred option to maintaining paper charts. A discussion of this technology warrants an entire article in and of itself. Suffice it to say that the decision to purchase an EMR system is a big one for a physician to make, and that careful evaluation as to its capabilities is warranted because of the price tag associated with such a system.

Electronic patient statements. Virtually all practice management systems allow for electronic submission of claims to insurance companies. Some vendors provide this capability for patient billing as well. This feature eliminates the need for the practice to print and handle patient statements.

Each week or month, the practice transmits patient statements electronically to the vendor (or to a clearinghouse used by the vendor) via modem. Patient statements are then printed and mailed to the patient along with return envelopes. There is a cost (normally about $ .50, including postage) for each processed and mailed statement. By processing electronically, a practice can save time and labor, thus increasing the productivity of the office.

Electronic payment posting. Several vendors now offer modules that allow for electronic posting of insurance company payments directly to the patient’s account. This eliminates the need for “hand posting” of payments upon receipt of the paper explanation of benefits statements (EOBs) by the practice. This is also a time-consuming process, particularly for larger practices. It is important to note that a limited number of insurance companies currently offer this option. In Pennsylvania, Medicare-PA and Blue Shield-PA have made this option available.

Other electronic interfaces. Some vendors provide interfaces which allow a practice to interface with computers outside the practice such as labs, hospitals and collection agencies. Some interfaces export or import data while others interact with the menus of other systems.

“Letters” modules. These options allow for integration and merging of patient demographic data into letters and can be used for developing routine or business letters sent by the practice.

Application service providers (ASPs). This is a relatively recent, generally low-cost option, particularly for small practices. ASP’s use the Internet to deliver information technology services and software such as patient scheduling and billing systems. The software is, in essence, rented, and the ASP provider maintains, supports and updates the software as needed. With an ASP, the practice relinquishes direct control of the data because it is stored on a server off-site. Many times, a practice can use its existing PCs to operate these systems. Or, the ASP may rent the hardware to the practice. Because ASP technology is a relatively new technology, physicians should be extra careful when evaluating this type of option.

After choosing three or four vendors that appear to meet your practice’s specifications, ask them to meet with you and key staff to demonstrate their products. Be sure the vendors know that this is a competitive bidding process. Remember also that “everything is negotiable,” as most vendors build in a larger profit in their proposals than they expect to make.

A final few words of advice. Communicate the implementation plan to all employees and be sure your office is adequately staffed to serve patients while the training process is under way. Insist that the vendor representative be accessible during the startup period and expect a few glitches. These are inevitable but will have less impact on the practice if the vendor is on site to assist and answer questions.

Sherry Migliore, MPA, is Director of Consulting, Eastern Region PMSCO.

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