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It’s difficult to imagine successfully running an occupational medicine clinic in today’s environment without the aid of a practice management (P-M) software system. Systems currently on the market handle everything from billing to medical surveillance, from scheduling to Occupational Safety and Health Administration (OSHA) compliance. Costs vary as well, from $2,500 to literally tens of thousands of dollars. With so many choices available, how can occupational health managers be sure they are selecting the most appropriate system for their facility? Occupational Health Management canvassed both vendors and users for the answers.
Most observers say that you can’t have it all with any one system. The people who created these programs, they note, come from specific disciplines and therefore have distinct areas of expertise that is reflected in their software.
"All systems have strengths and weaknesses," notes Steven C. Schumann, MD, founder of The Stolas Group Inc., in Fresno, CA. "The applications tend to track to some degree the expertise of the developers. I had an occ-med practice for many years, so the kinds of things that were important to me in my practice tend to be important in StolaSystem software."
"To an extent, it’s true that you can’t do it all," adds Joe Fanucchi, MD, FACOEM, president and director of development for MediTrax, based in Alamo, CA. "Realistically, there is a range of services and functions that most outpatient facilities want and need. These include accurate documentation and tracking of services they provide; accurate and reliable billing and [accounts receivable]; and thorough reporting for the jurisdiction they are in — for example, workers’ comp. You can have a very good basic package."
That opinion is not universally shared, however. "I think our system does provide it all," asserts Mary Price, president of Monterey, CA-based Integritas, Inc., which makes the STIX system. "What’s different is that systems approach things differently. So, for example, we came to this endeavor with a business accounting background. We have a high concern for our clients being able to pass a financial audit; there is a very robust trail [of data]."
The key players in this market are known by their size, their unique system benefits, or some combination of the two. Most agree that the industry leaders are the three "S’s": SYSTOC, which is provided by Skowhegan, ME-based Occupational Health Research (OHR), STIX, and Stolas.
"We tend to compete among ourselves for most of the large pieces of business," says Schumann. "Several other [leaders] are smaller companies like [Occupational Health Manager (OHM)] and MediTrax. Pricing [for the larger system providers] tends to exclude the single practices. STIX has a version that runs on a smaller database, a less expensive lite’ version. SYSTOC and Stolas require larger databases."
What distinguishes Schumann’s system? "Our group module as well as our occupational health module, our Internet connection, and remote access — a web-based ability to see some restricted patient and claims submission data," says Schumann.
The clinic manager establishes the kinds of data he or she wishes to be accessed, Schumann explains. "So you don’t always have to call the clinic to get information on a patient for whom you are responsible — and it’s a secure system," he says. "It’s attractive to managers of programs. It not only cuts down on calls, but tends to reinforce relationships."
Electronic claims submission is also in place and working, he notes. "We find many users are hospital systems that also do urgent care," he notes. "The ability to add occ-med into urgent care seems very attractive." Reinforcing the notion that not all systems are created equal, Schumann concedes that "ours is recognized as not being as strong in employee health compared, for example, to STIX."
Price, however, prefers to emphasize her system’s accounting control. "You can go in any time and know what’s been billed, what’s not, and do a transaction by transaction audit. You can’t do that with other systems," she asserts. "We’re also very strong on the clinical record — not only standard P-M billing and scheduling, but we have a clinical problems list with very robust medical surveillance capabilities," Price adds. "Users can look at clinical results — not just whether a hearing test was conducted or lab values were run, but they can capture the clinical results as well. You can then determine that your population has a problem with, say, chronic back pain."
On the injury side, Price claims to have a very strong case management function. "The other big thing we have I don’t think the others have is a whole safety component," she observes. "Our clients can track safety data, and do an OSHA log over our system."
"Ours is a text-based system," Fanucchi notes. "The first two [P-M] programs were SYSTOC and ours. But they are at the high end of product pricing; we are at the low end. Once we were up at $20,000, which I said was ridiculous. I’ve seen people paying $50,000, $60,000, $80,000, or even more than that for packages that don’t do what they claim. We now charge $8,000, including on-site training."
His system does not do case management, "but it hopefully provides data support for a trained professional who does," he says. "Some software vendors say you can click a button and see how much you can save vs. the clinic down the street, but that’s a fraudulent claim."
Fanucchi described his system as "an intuitive, menu-based system that follows the work flow. This can be a weakness if you want to do sophisticated data crunching. We don’t have automated interfaces to spreadsheets, or some features that are available in programs like SYSTOC, such as the ability to store pulmonary function flow volume loops, or automated interfaces to a lot of electronic machinery."
MediTrax has "a fairly sophisticated accounting system," where each injury and each employer have an account, and the report is manageable by an individual worker, visit, or service, Fanucchi says. It also provides case management support. "We don’t track indoor air radon on a day when the wind is five mph outside," he concedes, a bit tongue-in-cheek. "We don’t do indoor hygiene tracking or accident tracking functions. KNORR Datapipe does that."
Despite distinguishing systems features, "All of us are coming closer together, even though we started out from different places," says Schumann. "I think we will all come even closer, but we will never become concentric circles."
With so many options available, the P-M software decision can be a difficult one. Budgetary considerations are a given, but Fanucchi warns you shouldn’t make too strong a connection between cost and value. "We had exactly the same software one year [priced at] $7,000 and when we kicked it up to $20,000, interest skyrocketed," he recalls. "The more it costs, the more some people perceive it is worth. That’s frustrating to me."
What other factors should occupational health managers consider? "You have to decide what your priorities are," says Schumann. "Are they clinical and operational, or back-office reporting and number crunching? Are you interested in lower upfront cost, or lower maintenance costs?"
In other words, look at your specific needs. "Also, clients will tend to appreciate different chemistries with different companies," Schumann notes. "Personalities definitely come into sales."
"The biggest factor is the reputation of the vendor," says Price. "Then, what you really want to think about is if there’s a certain style and approach to running your practice. There are people who look at one particular system and say, Oh my God, it works just the way we do!’" When interviewing vendors, don’t just ask them what their turn around time is, but how many open, unresolved calls they have at end of the week, Price advises. And ask if they will consult on work flow. Finally, she says, ask if a warranty is provided "It’s fine to buy an $8,000 program, but if there are no warranties why would you do that?" she asks.
The potential buyer should also be wary of flashy demos. "If OHM could really do everything they say they can do — they have a magnificent-looking demo — and do it without you ever getting lost in multiple windows, the rest of us would be out of business," says Fanucchi.
"I think demos give users a psychological comfort, and they’re valuable from that sense," says Price. "But their actual operation may be different than what you’re looking at. It doesn’t matter whose system you buy; listen to what the vendor tells you about setting up and using it."
Once the system is up and running, how do you determine if you’ve really made the right decision? "You should run the system six to eight months," says Price. "I don’t care whose system you put in, it will take time for the user to work the kinks out. Almost nobody is willing to pay for work flow consulting, and I think that’s a huge mistake. A lot of people think they will put the software in and it will automatically solve everything. The P-M system is the backbone of your operation, but some of your problems may be work flow problems, not software problems."
The other big mistake she sees people make is that they don’t budget for turnover and retraining of their staff. "That’s our biggest problem with clients; they don’t budget, and over the years if people are not properly trained, the system will not pay off the way it could." Finally, Price advises, "Check how often you are getting updates, and how quickly your issues get resolved."
How should vendors respond to the need for system modification? "It depends," says Schumann. "We all respond, but we tend to stay away from any more customization than is needed because we have to support it, and we all bring out new versions once a year or so; and when you upgrade you have to be sure what you do doesn’t influence that customized work. The point is you want to be as broad and as deep as possible."
The need for a change, if there is one, will be readily apparent, he says. "If you find at some point your needs are progressively less well-met, then you will begin to look at competing systems," he says. "But the five-year cost of any of the top systems is probably $100,000, so you just don’t make changes on the spur of the moment." SYSTOC tends to lease its system, while STIX and Stolas offer only sales, he adds. (How does the selection process look from the clinic’s point of view? See "Users share details of selection process," in this issue.)
The rapidly changing world of technology will dictate the future evolution of P-M systems, say observers. "We are affected by what Bill Gates and the others are doing," says Schumann. "That will improve what we can deliver every year, but every year the systems become more complex, and may be harder for the user."
That’s a significant concern, he emphasizes, because of the growing role of the clinic and its staff in the use of these systems. "When we first began, we installed the software and maintained the whole thing," he recalls. "You just can’t do that now; it has to be managed at the clinic level."
The original systems were all DOS applications, he notes. "Back then, your teen-age son could install the network," he says. "With Windows, that’s not the case. Everyone has 2000 or NT [versions], and now XP is coming. The requirement for technical support is a good deal greater; in fact, it tends to drive or influence the decisions users make about system selection."
Because of the advanced technology, vendors today need to have solutions to database management and network administration problems, Schumann notes. "Also, with voice recognition and palm technology, there are imaging issues," he observes. "So you have to consider the technical support a company can offer, and a lot also falls on the clinic to find its own support, for example, in network administration."
"We are working towards having more collaborative information-sharing with employers and insurance organizations," Price reports. "Companies are looking to eliminate some of their redundant data entry — streamlining operations so providers can bring their AR days down."
[For more information, contact:
• Mary Price, President, Integritas Inc., Suite 112, 2600 Garden Road, Monterey, CA 94930. Telephone: (831) 667-2266. Fax: (831) 657-2000. Web: www.integritas.com.
• Steven C. Schumann, MD, The Stolas Group Inc., 6061 N. Fresno St., Suite 104, Fresno, CA 93710. Telephone: (559) 431-9450. Web: www.stolas.com.