By Morris W. Stemp, CPA, MBA, CPHIMS, and Beverly Wachtel, February 02, 2015
Medical practices don’t have computers and diagnostic equipment in the office because the doctors and staff love technology. They have this technology because it is required to take care of patients, run the office more efficiently, and get paid faster. There are many technologies and options available. Choosing the optimal solution can enhance the lives of the doctors and staff, and create an enjoyable patient experience. Choosing the wrong solution can be very frustrating, inefficient, and costly. Even more costly is the time and money to move from the wrong solution to the right solution (a task unfortunately performed at some point by almost 50 percent of EHR users). So how do you choose?
The most central technology at any medical practice is the EHR including the practice management (PM) module. As you probably already know, a good part of a physician’s and staff’s work day revolves around using this technology, and using an EHR changes a practice’s entire workflow. You’ll find more information about choosing a dermatology-specific EHR, and technology which integrates with it, in the sidebar.
Choosing the right tech solution
Given all the complexity and options, how do you choose the right tech solutions? While there are many choices to address some needs, you’ll find that there are very few choices for others. While cost will always be a consideration, a system that is easier to use will lead to greater productivity and be less costly over time.
The steps of the process:
1. Understand your needs
It may seem obvious, but before you even consider a technology solution, you need to understand and document the problem you are trying to solve. Frequently, our clients know they have an issue but have difficulty articulating and documenting the details and nuances of the issue. This documentation is critical to convey your needs to possible solutions vendors and to evaluate the degree to which the solutions meet your needs.
2. Create an evaluation team
The staff members who eventually use the solution are the best group to be involved in both documenting the need and evaluating the solutions. You’ll also have more cooperation from the staff in implementing the chosen solution if they have input into making the decision.
3. Learn the options
Researching the available technology options that might meet your needs is the next step. Searching the Internet, contacting vendors, attending dermatology and health IT conferences, as well as speaking with colleagues and with IT consultants, will expand your awareness of all the options and reveal a range of pricing. Gaining this awareness will also lead to further refinement of your needs.
4. Set a budget
Now that you have an idea of the possibilities and range of costs, you can set your budget and refine your choices to those that fit within your budget. Be sure to consider not only the cost of the software and hardware alone, but also the cost of implementation, training, maintenance, and support.
Do you have the funds available or will you consider financing the solution? If the purchase cost is substantial, you should discuss the income tax issues regarding purchasing and financing the equipment with your accountant.[pagebreak]
5. Write a request for proposal
When choosing an expensive technology solution such as an EHR, prepare a request for proposal (RFP) for each vendor you are seriously considering. This document tells the vendor about your practice and your priorities in choosing a solution. By submitting an RFP with blanks for the vendor to fill in answers, you will be able to do a side-by-side comparison of solutions from different vendors. The RFP should include the following information.
• Your practice information — size, location, computer hardware and network information and any product you currently use for the same purpose.
• Your practice’s goals for functionality — prioritized
• Request for vendor information — history, number of employees (for sales/support/research and development, and management), financial statements, product history, list of current dermatology users of that product that are similar in size to your practice
• Request for product information — how it performs your prioritized functions, other functions it performs, software versions and release dates
• Hardware and network requirements to use their product
• Maintenance and support provided and related costs
• Training provided (included and for additional cost)
• Details of a proposed implementation plan
• Integration and interface capabilities
• Proposed costs and payment schedule
• Sample contract
6. Select vendors to consider
Compare the RFPs and select the vendors of a few products you would seriously consider. If choosing an EHR, consider vendors that have EHR systems that are specific to dermatology, integrate with the other products you want to use, and have favorable ratings.
7. Schedule a demonstration
Invite the vendors to come to your office to demonstrate functionality and workflow of the technology. (Some technologies have online demos, but it is preferable to have in-person demos for a system as pervasive as an EHR or PM system.)
When vetting an EHR, look at the layout of the screens. Does the design of the screens make the steps to document a dermatology visit intuitive? Does the EHR have the option to draw on the screen (with your finger or stylus)? Does the design enable you to easily input data, construct queries, and create reports so that the EHR will be more useful than a paper record? How many clicks does it take for each visit? Extra clicks take more time, so make sure the next steps flow and the screens are easily accessible. Is the EHR easy to use on a laptop, tablet, or smartphone?
Provide the vendor with scenarios to find out if the product meets those needs or can be customized. Ask the vendor about integration with other systems. Which practice management software integrates with their EHR? Is the EHR part of a suite which includes the PM system?[pagebreak]
Be sure to let staff participate in vendor demos to see if the EHR meets their needs as well, since they will be using different functions of the software. Everyone who will be using the system should have input, including clerks, medical assistants, nurses, and doctors. There needs to be buy-in from the whole team to ensure that implementation of the EHR will be successful.
Ask about training and support for the product. If you are replacing your EHR, ask about moving the data into the new system, or creating an interface to allow you to access data from your old system.
Upon moving to a new system, it’s important to consider what you are going to do with your old system and if you still need access to it. If the old system is a cloud-hosted system, maybe you can negotiate a lower rate since you will no longer be actively using it? If the old software is running on some old server, do you expect that server to be stable until you no longer need access to your old software? It may be possible to move the old system into a hosted environment where the system can be kept alive so you can access it.
8. Check references
Check with other physician users and ask each the same questions about the solutions you’re considering. Compare their practice with your own. Inquire about their usage, the training and support they’ve received, the hardware that was required, how the product was implemented, and their satisfaction rating. Also check references with IT consultants. Then do the same type of side-by-side comparison of the responses.
You might even consider asking the vendor for references to practices that were using their system but are no longer using it. Speak with those practices to find out why they switched away from the system you’re considering.
9. Visit other practices that use the solution you’re considering
If you don’t know of other dermatology practices the same size as yours that are using the solutions you’re considering, visit the practices recommended by the vendor. Recognize that the vendor will only choose practices that are happy with their product, but it will give you the opportunity to see the product being used in an office environment. Pair a doctor from your office with a doctor who uses the product, and pair a practice manager with a practice manager, to observe the workflow. Watch how the product is used and ask questions about how the technology functions. Ask about their experience working with the vendor including the training, updates, and support provided. This is especially important in choosing an EHR since the EHR is a game-changer for your practice. Be sure to take notes.
10. Rank the vendors
One of the most difficult aspects of evaluating possible solutions is determining which solution does the best job of meeting your needs.
Rank the vendors using the results of the product demo and references, based on how they meet your goals and priorities. Consider not only functionality and cost, but also the implementation, training, support, how the product is maintained, and the long-term viability of the vendor.[pagebreak]
If the solution you are considering has a lot of features to compare, it is a good idea to develop an evaluation matrix. For the columns list the goals you want to meet by using technology, and for the rows list the names of the technology solutions. You’ll find more criteria as you do your research, and then you can ask the vendors whether (and how) their product meets those needs.
11. Select a solution
Compare your notes from the office visits to your notes from the demos and the RFPs. Select the best, and the second best, solution for your needs. If you are not happy dealing with your first choice when negotiating your contract, you’ll be ready to proceed with your second choice.
12. Negotiate a contract
Your contract is just as important as the technology you choose.
Most EHR vendors offer standardized contracts with some negotiable terms, but some will not negotiate terms. It is a good idea to consult an experienced attorney for help with contract negotiations. The Office of the National Coordinator for Health Information Technology has a guide that explains key contract terminology and how it may impact a physician’s practice. We strongly recommend that you read it.
Ask for a trial period and escape clause. Also, review the terms of the training: find out how much training is included in the price and how much it costs for additional training later.
Skipping some steps
It is clear that some of these steps are not necessary for every technology solution you purchase. If you are the only one using the technology, you don’t need to create an evaluation team to choose it. There may only be one reputable vendor for the solution you want, so the RFP may not be relevant. You may simply decide to use the same technology your favorite colleague uses or that you were exposed to in medical school.
Assessing the solutions you’re considering
If you’ve prepared a matrix to compare products, you’ll find it is relatively easy to see which solutions have which features. Evaluate which features are most important to you, and eliminate the products that don’t have those features. Then, as you do your side-by-side comparison, decide which remaining features are more important to you and move the products that have those features to the top of the list.
Getting the most out of your IT
When you choose a technology solution, you want to make sure that the technology helps you improve productivity. To get the most out of your IT, you will want to make sure that the technology solutions work together and that you know how to use them. So it boils down to integrations and training. If the product integrates with your EHR, the information gathered and produced by that technology will move directly into the patient records in the EHR, eliminating the need for data entry, which saves time and improves accuracy. With more training, you’ll know how to use more of the features of the product and the most efficient way to use it. Both will lead to improved productivity, accomplishing your goals of taking care of patients, running the office more efficiently, and ultimately, getting paid faster.
Technology designed for dermatology
EHR and practice management
The electronic health record is an electronic version of the patient chart, including the medical history, demographics, progress notes, problems and medications. The practice management portion of the EHR manages appointment scheduling, secure messaging, reporting, document management, and billing.
Some of the features which make an EHR specific to the practice of dermatology include:
- Dermatology and cosmetic surgery specific templates (such as acne, psoriasis, lesions, rosacea, and cancer screenings)
- Dermatology workflow management
- Dermatology-specific procedure and diagnosis codes
- Dermatology-specific clinical decision support
- Graphics of each area of the body on which to identify the location of and draw the dermatologic condition
- Ability to store before and after photos of patients
- Ability to draw directly on photos to demonstrate location of treatment using touch-screen or digital pen
With so many EHR choices, it will be helpful to follow a very comprehensive selection process like the one described in the main article.
You’ll want to make sure you’re happy with the EHR that you’re using before you start focusing on add-ons and integrated technologies. Make sure that the EHR you choose can be configured to access your local Health Information Exchange to comply with the HIE requirements of meaningful use. In addition, make sure that the solution will enable you to transition smoothly to ICD-10.
Dermatology solutions that integrate with EHR
There are many technology options that integrate with EHR systems. Data only has to be updated in one application and the changes are automatically made in the integrated systems. Integration benefits the practice by increasing efficiency and reducing errors due to manual entry of data.
One of the requirements of meaningful use is patient engagement. Engaging patients with secure communication through a patient portal can also save your practice time. The portal enables patients to schedule and view appointments, receive communications from your office, and access portions of the patient’s medical record. Most EHR systems offer a cloud-hosted patient portal. There are also non-product specific portals which may integrate with your EHR such as Omedix, InteliChart, and Updox.
Many physicians like to use dictation services to document their notes instead of typing and clicking through their EHR. Dragon Medical by Nuance is the top selling transcription software for health care. Many EHR systems integrate with Dragon for documentation of notes and even for navigating around the system.
E-prescribing is built into most EHRs. For physicians not using an EHR, standalone options are available through Surescripts, MDToolbox, DrFirst’s Rcopia, and the National ePrescribing Patient Safety Initiative. Surescripts is an e-prescribing network which covers more than 90 percent of U.S. pharmacies. (MPR discontinued its ePrescribing service effective August 2014. Refills can be transferred to another e-prescribing service).
Clinical decision support
Clinical decision support (CDS) is interactive software used at point of care that works with the clinician’s knowledge to assist in diagnosis and analysis of patient specific data. It is built into most EHR systems. A standalone version for dermatology, available on desktop, smartphones, and tablets, is VisualDx.
Instead of receiving your lab and pathology results by fax and having to manually file them in the patient charts, you can save time by having the results transmitted electronically from the lab and attached to the patient record in the EHR. All of the major medical laboratories set up integrations with EHRs, including Quest, Labcorp, Sunrise, and Shiel.
Storing and accessing photos is essential for dermatology. Options were discussed in the October 2012 Technically Speaking column.
Integrating informed consent into your technology process helps to limit your liability. This was discussed in the October 2014 issue.
There are many HIPAA-compliant methods of communication that you can use to collaborate on patient care such as text-like applications, encrypted email, and e-fax. Options can be found in the June 2014 issue.
Sometimes it is helpful to work on documents with patient information outside of the office, or in collaboration with another provider who is not in the same location as you. Using a HIPAA-compliant cloud-storage solution will enable this process, as discussed in the February 2014 issue.
Your smartphone can be used in many ways to improve productivity in your dermatology office. If you do use smartphone apps for clinical care, ensure that your mobile phone is password encrypted and download a remote wipe app such as Find My iPhone.
There are skin scanner solutions that turn your smartphone into a dermatoscope, like the DermLite and the Handyscope, and imaging apps that associate patient metadata with the image like the tKDerm Touch. (See the October 2012 issue.)
If you’re looking for easy access to information, there are also apps you can use on your smartphone or computer to access online materials, like Medscape for research and Epocrates for drug reference.
Many of the hundreds of dermatology smartphone apps are designed for patients. If you decide to use them, check the ratings; most are not rated well. One that we like that is patient centered is ZocDoc. Potential patients, who download ZocDoc for free, use it to look up doctors in the area who take their insurance, and book appointments. Physicians pay a flat fee of $300 per month for a listing and the app syncs with the PM scheduling system. The cool thing about it is that the app tracks cancelations, enabling patients to book appointments in those slots.