Turnkey or best of breed: Which works for you?

Here’s a look at the types of products available

There are two approaches to choosing technology for a physician practice: turnkey and "best of breed," according to Richard Rutherford, CMPE, former administrator for Urology Associa-tions of Southeastern North Carolina in Wilming-ton. He recently joined the American Urological Association in Baltimore as head of its practice management section.

If you choose a turnkey approach, you’ll buy all your software from one vendor, or from a reseller who contracts with another company with a compatible software package — the two vendors get together and build the links.

When Rutherford purchased his practice’s first medical records and billing system, he took the turnkey route. For the most recent purchase, he bought from more than one vendor because no one had everything he needed.

When you start your technology-purchasing project, you’ll probably want to look first at software. Software for physician practices includes practice management software, clinical applications software, physician support software, and decision-support software. (For a list of what each will do, see box, p. 69.)

"In each of the four categories, most vendors will proclaim that their product will enhance quality, service, and cost-effectiveness. Most can and do save time, improve efficiency, and give more time for patient care if the practice is utilizing the appropriate software for its needs," says John Spearly, vice president of Phoenix Health Systems, a health care information technology consulting and outsourcing firm in Washington, DC.

If your practice chooses a Windows-based system for electronic medical records, it will be easier for all your software to interface, suggests Julie Elmore Jones, MBA, MHA, a consultant with Gates, Moore & Company, a management consulting and accounting firm in Atlanta.

Windows vs. UNIX

The majority of computer patient record systems will interface only with a windows system, she adds. "That’s where everything is moving. A Windows-based system should be able to provide better management reporting capabilities. This is extremely important."

In the past, most billing and collection software was UNIX-based. Some vendors tell clients their system is Windows-based when it’s actually a UNIX system with a Windows overface, she warns.

"These days, nobody should be looking at something that’s not Windows-network capable. The ability to transport data from one platform to another is what’s going to make the difference," adds Rutherford.

Here are some more technology options:

Hardware options

In most cases, your hardware purchasing decisions will be based on the software applications and software vendors you select.

You need to determine how big a computer or server you need and how much disk and storage space you need, based on the size of the practice and number of patients served.

Your needs will range from one server with two or three computers for a small practice to a large network system for a large integrated health care delivery system.

User interface options

Your choice may be a traditional hard-wired terminal located in an office or examination room, a mobile device such as the personal digital assistant, or a laptop on a mobile cart. In choosing the type of user interface equipment, you should take into account what works best for the physicians in your practice.

Another consideration is what physicians will need for remote access when they’re away from the office. This could be a traditional dial-up to an office computer system through the Internet, or cell phones with an integrated Web browser that allow you to dial up the system from wherever you are.

ASP provider arrangements

Application service providers (ASPs) allow their customers to run standard software applications through the Internet using a virtual private network. The advantage is that the practice doesn’t need to purchase the hardware and software; users just log onto the network.

"The Internet has enabled this method of application delivery to be much more efficient than in the past. More and more ASPs in the physician practice arena give physicians more options," Spearly says. An ASP arrangement is not necessarily a more cost-effective solution than purchasing your own software, but it is one that should be explored as an alternative, he adds.

Voice recognition technology

This technology allows the user to speak into the computer, which transcribes the sounds into words on the screen. Users must "train" the system to learn their speech patterns, a slow process that involves speaking into the computer and making corrections on the screen.

The technology gets mixed reviews from practices that have tried it, Jones says. "In the beginning, it’s a slow process, but it’s an area where we expect to see better technology come out in the next couple of years."

Physicians who don’t want to take the time to train the system aren’t happy with it, but others enjoy it and feel it makes a positive contribution to their practice, she adds. "You have to speak slowly, so I wouldn’t say it saves them time. It may save them some money in terms of transcription expense."

On-line patient services

"The Internet is changing the way health care operates. We’re seeing much more use and demand of the Internet and connectivity by patients," Spearly points out.

Some progressive practices offer on-line services to patients, Jones says. Those include appointment scheduling and on-line laboratory results.

"If you’ve got the right patient population, the patients love it. If you’ve got a heavy Medicare population, think twice about offering on-line services," she adds.

She warns that practices should be careful to comply with security regulations required by the Health Insurance Portability and Accountability Act if they are going to be sharing clinical information on the Internet.

"We’re seeing a move toward on-line services. It will save costs in the long run, but more importantly, it caters to the patient in a managed care environment," Jones says.

For instance, when patients have surgery scheduled or have to be pre-authorized for a visit, they can check on-line to make sure everything is in order rather than going in for the visit, finding out the treatment hasn’t been approved, and having to reschedule.