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    Research office management system before purchasing

    Focus on the long term to increase efficiency, reduce overhead/staff costs, enhance patient service

    Like an old car, our office practice management system ran well for about 10 years and then gave up the ghost. Actually, it wasn't so much the system that failed as the company that sold us the system and helped maintain it.

    This firm specialized in office management technology for eye centers, and as an ophthalmology group it was a natural choice for us. However, it was part of a larger eye care company that no longer wanted to be in information technology (IT). The firm gave us 3 years to find and install a new system, which we did just before our old provider rode into the sunset.

    As we have discovered, medical office management systems providers come and go, and our experience isn't that unusual. Many groups have had systems providers go south on them, others are using systems that are simply obsolete, and some groups still have not automated their practices. Physicians in any of these positions may find our experience instructive. Here are some suggestions for groups looking for a new office management system or considering automating their practices for the first time.

    Know where you want to goOur group consists of six ophthalmologists, three different sites, and about 40 systems users. Within the group we operate five different companies, each with its own tax ID number. We offer most of the services in the realm of eye care-cataracts, retina, glaucoma-and we have a surgery center and a LASIK center. The marketplace is growing and we hope to grow with it. We quickly recognized that the system we needed had to be "scaleable," a term coined by the IT people. To purchase hardware and software that fit our current needs but would be obsolete in a year or two clearly would be a waste of time and resources.

    The first task was to determine where we thought we would be 3 to 5 years from now. Our vision included adding several more sites and about 15 or more new users. Had we wanted to sit tight and simply manage current volumes more efficiently, we probably would not have made some of the decisions we ultimately did.

    Given our desire to grow, we decided to embrace technology that could make us more efficient, improve patient service, make us more responsive to market changes, and give us a competitive edge. Features and benefits of a new system had to be closer to a Lexus or Mercedes than to a Yugo or a Neon. We needed standard office applications such as Excel, Microsoft Word, Power Point, and Outlook. We also needed Internet access,e-mail, and hosting services for our Web site (www.keywhitman.com). All billing, collections, scheduling, and reporting functions had to be covered, as well as the capacity to implement electronic patient records.

    Because of our multiple locations, we needed a secure intranet system on one local network capable of instant cross-clinic com-munications. Thanks to HIPAA and other security concerns, we needed a system with strong firewalls and powerful virus protection. To maximize use of our time, we needed a wireless system accessible by laptop from the home or on the road. To free up staff time, an automated phone system was installed to remind patients of appointments.

    Some physician groups may determine that basic back-office functions are all that matter. Others may wish to achieve as many technology-based efficiencies as possible. In the end, "what really matters" will depend on your vision for the group.

    How technology has evolvedIn the old days of high tech (about 4 or 5 years ago), medical office systems came in tidy packages. A practice might have servers, printers, workstations, or terminals all derived from the same manufacturer, and the only software running on the server was the medical system. Now, hardware and software components come from multiple sources and getting them linked and keeping them in balance can be very difficult. Internet connectivity, with its security and virus issues, only adds to the complexity.

    Enlist your alliesYou can't really try out an office practice management system and then return it to the dealer if you aren't satisfied. However, you can "test drive" the systems your peers are using in their practices, which is the next best thing. We personally visited other eye centers and spoke to the most technically savvy partner or manager about what they liked and didn't like about their systems. In particular, we asked where application and service problems were most common and what they did about them.

    Know your vendersThere are three basic types of systems vendors from to choose:

    • Vendors who sell, install, and support their own software.
    • Resellers who sell and support software written by someone else.
    • Application service providers (ASPs) who sell, manage, and host software applications at their own sites and charge clients on a subscription basis.

    Any one of these can be a good choice depending on your vision and needs. Before you make a selection, however, ask to see one or two of the vendor's systems in place. The vendor should be willing to arrange tours of practices where their systems are working, without being present on the tour themselves.

    After researching the options, we chose a locally based ASP to design, install, manage, and host our system. The decision to go with an ASP was based on the fact that we had a fairly ambitious vision, yet could not afford the type of chief information officer (CIO) needed to maintain the system we wanted.

    In addition, given the complexity of today's systems, it is difficult to find one person who can troubleshoot everything. The ASP model offered the team approach to systems management that we needed, as well as the "scaleability" we were looking for.

    Take it one step at a timeYou don't have to do everything at once. We started with the essential back-office functions (billing, collections, financials, scheduling) and built from there. For the sake of group buy-in, it's important to start with applications that can demonstrate quick bottom-line benefits, such as more accurate claims and faster reimbursement.

    Office management systems today are not like that old station wagon or pick-up that just kept rolling no matter what happened. They are more like sports cars-high-strung machines that need a lot of attention. So expect pit stops and don't be too frustrated by them.

    Focus on the long termGood office management systems can increase efficiency, reduce overhead and staff costs, enhance patient service, and maximize reimbursement. But they don't do so overnight. We feel we have a good system in place now that will allow us to grow while meeting ongoing cost, compliance, and patient service challenges. But the world has not suddenly changed from black and white to color, as it did when Dorothy landed in Oz. Changes are more subtle and can only be addressed over time.

    But the fact is that we did change. We had to.

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