Analyze practice needs when you computerize

Gain expertise before you shop

As director of medical recruitment for Duncan (OK) Regional Hospital, Rick Buchanan knew his job well when he hired the physician who would practice at the hospital’s first freestanding clinic last year.

But when Buchanan took on added responsibilities as director of the clinic shortly before it opened, he confronted a series of questions he’d never been asked to answer before — issues that other physician relations professional (PRPs) could face as they move into consulting with the physicians who practice at their hospitals.

One of those issues concerned the clinic’s computer system and how to make it work properly. Just days before the clinic’s opening, office staff weren’t thoroughly trained in how to use the computers. Another surprise lay in the system itself: It was purchased before Buchanan assumed his new duties, and it had trouble communicating with the hospital’s system.

Both problems stymied operations during the clinic’s first days. Looking back on the experience, Buchanan notes several things that should have been done differently. "You either must have the expertise yourself or know someone who has the expertise" in buying and installing computer systems, he says.

Getting a good fit

Buchanan wishes, for example, that there had been a more careful examination of what the clinic required from its computer system. Experts agree with Buchanan.

"The first step is to understand what it is you need," says Richard A. Helfrich, MBA, vice president of Medical Alliances, an Alexandria, VA, consulting firm that specializes in health care business development and interactive communication services. Helfrich also has experience in purchasing computer systems and equipment as the former executive director of a managed services organization in northern Virginia.

Determining your current needs might seem easy enough. If, for example, most of the practice’s patients still carry fee-for-service insurance, you’ll obviously want to investigate software programs that include dependable billing features.

With the quicksilver changes taking place in computer technology, however, it’s easy to overlook useful system options that are newly available. It’s even easier to buy a "must have" feature that’s obsolete six months after the system is installed.

The ongoing metamorphosis in medical business practice also complicates the purchasing decision. Managed care might not have penetrated your area yet, but the revolution in health care virtually guarantees that you’ll soon confront this delivery system. Or, while you might be dealing with managed care now, you may have relatively little experience in calculating the demographics that play such a large role in capitated per-patient fee schedules. How can you buy today with an eye toward those future needs?

For those who don’t know how to make these decisions, Helfrich suggests several features practices should look for when they shop for computer systems:

How well can the system "talk" to other systems?

That ability becomes a key concern when you need to receive ("import") data from another system, such as when a specialist’s office sends test results to a primary care practitioner. In computing parlance, you want a system with "open architecture," which means the manufacturer’s specifications make it easy for other companies to design products that work well, or are "compatible," with the device.

Both a system’s hardware and software should have an open design. Hardware refers to the machines that run the system, such as the monitor, printer, and the computing unit itself. Software is the set of electronic instructions — the programs — that tell the system what to do.

"More and more, what you need is a system that can interface with other systems," Helfrich says. "If you have closed-architecture, or proprietary, software, then programming for importing and exporting has to be done by the software company, at a very high cost."

How will you get support if something goes wrong?

Will the system’s vendor provide prompt help? When you’re considering the system’s hardware, for example, find out if you’ll be able to replace a broken part easily. The support a software vendor provides also is critical. Check into how well the software publisher staffs its customer service telephone hotline, and how it provides service when clients need help on-site.

"That doesn’t mean you have to buy locally," Helfrich says. In fact, you’re likely to purchase from a nonlocal vendor. To find out whether the company you’re considering provides good service, ask other practices or health care offices in your area for recommendations. Or, Helfrich recommends you ask the vendor for a reference to a customer that isn’t located in the seller’s home city, and ask that client about the service it has received.

Does the software have a well-established reputation?

"People will try to sell you systems, saying, ‘We almost have it finished now,’" Helfrich says. Software publishers are notorious for releasing the first version of a program, then working the bugs out and charging for upgraded versions that are really little more than corrected versions. Instead of buying the first (or even second) version, opt for a program with a proven track record.

Reliability also is the reason Helfrich advises against agreeing to serve as a test site for software that’s being developed. Software publishers offer discounts to selected customers that use those pre-release versions and then give feedback on how well the products work.

You do, however, want software that essentially is under constant development. Buying from a publisher that’s always working to advance its system helps ensure you’ll be able to take advantage of technological breakthroughs.

Popular systems attract secondary modules

While you’re looking at software, keep in mind that you don’t necessarily need to buy a single, inclusive package. "It’s not like buying a Ford," with all options factory-installed, Helfrich says. "You can buy things to hang from it." If most features of one program meet your needs, but you’d like a different module for tracking patient addresses, it’s possible that another software publisher has designed a program that fulfills your requirements. That’s particularly true if you select one of the more popular medical management systems, which attract complementary development from secondary publishers.

How easy is it to become trained in running the system?

That issue applies not only to training office staff on a new system, but to replacement staff as employees leave the office. Practices usually "are lucky if Mary Jane leaves a note telling you how to turn on the system as she heads out the door," Helfrich says.

Once the new system is installed, try running it in tandem with your previous system, whether that’s on older computer equipment or less automatic methods, for at least one month, Helfrich suggests. Although the back-up work is time-consuming, it’ll protect you should you have trouble working with the new system.

"On one hand, practices with one to three physicians are almost a mom-and-pop business. But even a three-physician primary care practice easily generates $1 million each year," Helfrich points out. "If you choose the wrong computer system and that system is still for even a few days, nobody’s going to walk in the door handing you money." Obviously, the financial repercussions of system malfunctions could be severe.