New software in healthcare

Hardware capabilities and software functionality became remarkably more robust in the past decade. Technologies once dismissed as impractical are increasingly available at affordable cost and reduced risk. The combination of improved software, staff experience with home computers, and robust communication networks now provides a wider range of financially attractive opportunities to improve financial performance and care quality.

Rising Patient Expectations

Software providers have traditionally developed administrative systems from the perspective of the administrative staff or the physician. These systems focused on automating administrative and clinical functions aimed at improving staff efficiencies and reducing direct costs.

As seen in the retail and financial industry segments, consumers (patients) are rewarding entities that make it easier for them to interact. PM and EMR system development is giving more weight to the patient experience to help practices enhance patient satisfaction and perceived quality of care. Updated PM systems consider that patients (or their family advocates) want to schedule appointments outside business hours, complete forms before coming to the practice, and retrieve laboratory results thereby avoiding telephone tag or spending extra time in the waiting room.

Patients are becoming more engaged in making their healthcare decisions. They respond to clinical and administrative staff using EMR systems interactively and are encouraged to be more forthcoming and participative. Patients feel more confident at the end of the visit, and the EMR and PM systems can reinforce those positive perceptions by producing personalized educational materials, legible prescriptions less prone to misinterpretation or misuse, and reliable patient follow-up communications.

As patients assume more responsibility for their health care, they begin to view their healthcare records as belonging to them rather than to the practice. HIPAA provisions support this view and patients routinely request their medical records not unlike similar request made to financial institutions and credit reporting agencies. PM and EMR systems must provide the medical record availability needed to fulfill these expectations.

While practitioners have always stood accountable for their services, the standard rises as patients and regulators show decreasing tolerance for medical judgments based on incomplete patient records. High cost has been an available defense for not having a complete patient record, but newer PM and EMR software is considerably less expensive and is quickly eliminating cost as justification for incomplete patient charts.

Physician Practice Dynamics

Physician practice protocols vary widely throughout the broad range of practice specialties and physician philosophies on patient care. These variances create frustration and degrade compensation as health plans and regulators seek to impose uniform standards and procedures. While physicians are spending less time with more patients, they are also finding robust PM and EMR systems do help them improve physician efficiency and care quality provided they are willing to consider changes to their daily routine. Newer software systems built on reliable communication networks allow providers to prepare on schedules and locations of their own choosing, fully document their services and judgments, and assure compliance with prescribed patient follow-up procedures.

While patients say they want more time with the physician, they really seek a more confident and supportive experience over the entire office visit. Software should support the patient experience throughout the patient encounter as each clinical and administrative staff performs their individual service. Patient perceptions of quality care increase as they see their information recorded accurately and recalled reliably at each step of their encounter. The physician is rewarded with more complete and authenticated patient information and is thus better prepared to counsel and interact with the patient during their brief time together.

Physicians have a variety of philosophies and preferences regarding patient interaction and encounter documentation. The PM and EMR software industry remains highly fragmented offering a variety of approaches for supporting individual physician demands. Physicians no longer need to accept a “one size fits all” or “design it yourself” software offering.

Practice Economic Trends

Given the increasing patient expectations for quality care and the financial pressures of increased regulation, where does the physician turn to improve financial performance and strength? If the question is financial performance, then answers can be found in proven business practices. If the physician’s choice is to focus on patient care, then find someone else to focus on the practice as a business enterprise.

Increasing fees is not an effective strategy for increasing profitability. The business manager must focus on cash flow and cost control. Software providers offer a plethora of solutions to support both focuses, but software without workflow improvements will only automate current inefficiencies.

If cash is king, then start with managing cash flows. Modern PM software will quantify the financial impact of failures to collect co-pays, lost or unfiled claims, rejected and unresolved claims, and overdue patient accounts. These impacts identify where to start making improvements and measure the results of changing practice policies, procedures and workflow.

After workflow changes are defined, the practice can identify available software support. Some practices will find the need to replace an aging system, but more practices will find their existing software has functionality that was overlooked or ineffectively deployed. Successful software providers have a regular program of delivering software enhancements, yet many practices fail to update their software unless required or fail to implement new software functionality. A simple utilization review of the practice’s current software capabilities frequently identifies practical improvements that can be implemented with little additional cost.

Businesses that are successful in a competitive environment have a continual program of identifying opportunities for reducing costs and improving customer experiences. Medical practices can more readily implement such a program because both clinical and administrative personnel interact directly with patients. Practices can periodically evaluate the overall patient experience to improve documentation workflow, patient flow, and patient interaction. These evaluations then provide the needs assessment guiding PM and EMR software implementation and selection. Without these evaluations, competitive software selection is at risk of being unduly influenced by the most persistent, pleasant or deceitful sales representative.

Technology Maturity

Historical technology improvements focused on increasing computer processing power to run more complex software and increasing data storage capacity to hold ever increasing volumes of documentation and images. These improvements typically presented themselves as improved efficiencies in the administrative or back-office practice functions.

While those trends continue, newer technology improvements have focused on intuitive user interfaces and distributed communications. These newer changes make it easier for a broader range of practice staff to effectively interact with electronic records particularly when distributed over multiple offices. New wireless devices (laptops, tablets, PDAs) have brought effective data entry closer to the point of service and facilitate implementing needed changes to staff organization, patient traffic patterns, and documentation processing to increase efficiencies, care quality and patient satisfaction.

Internet security and higher transmission capacities effectively link a single electronic patient health record to multiple offices, remote physicians, transcriptionists and patients themselves. The improved communications technology now provides cost-effective means for widely dispersed medical operations to eliminate misplacing or losing patient charts. The technology also provides effective support to recover from a disaster destroying the practice’s physical facility or primary data storage. ASP providers can also become a competent ally in complying with HIPAA privacy and security provisions including providing a resilient platform for disaster recovery.

As Internet capabilities increased, most practices resisted embracing the technology believing that older patients would find the technology intimidating and the security exposure was unacceptably high. Medicare Part D showed that older people would use the Internet or find a family member to assist them. Software applications now support user interfaces (patient portals) allowing patients to schedule their appointments, make inquiries (ex. prescription refills), and retrieve test results.

Software Evaluation in Complex Environments

Traditional software providers attempt to understand their target customer and then create software to automate their customer’s business practices. Successful software providers develop PM and EMR systems that strongly consider the patient’s desire to have a more interactive and confident experience with their healthcare provider conducted at a time and place of their own choosing.

Software providers face a dilemma of how best to incorporate the multitude of software functionality demands within their offerings. The current controversy regarding whether one supplier should provide the entire set of software functionality under one corporate entity (the “enterprise” solution) is largely academic and played out primarily in competitive situations in which vendors have a vested interest.

The variety of software needs precludes any single firm from effectively providing the entire set of software applications. Even when attempted, the provider is pressured to shift development resources away from stable software modules to favor the offerings currently generating marketplace excitement. Vendors with multiple offerings find it much easier to discontinue (sunset) current offerings in the belief that most customers will feel compelled to migrate to newer, more expensive offerings.

Equally unattractive is interfacing disparate systems in a manner that requires complicated data processing platforms (ex. different operating systems or databases) or staff interaction to reliably pass patient information among the various systems. While this interfacing approach may allow “best of breed” selection among a multitude of software offerings, the combined system is expensive to acquire, implement and maintain.

A practical middle ground is to adopt an open strategy in which the software provider has demonstrated its dedication to continually improving its core offering while being open to integrating with other software modules that more effectively meet practice needs. Health Level 7 (HL7) standards have successfully guided development of reusable and reliable system interfaces that can be quickly implemented with little risk. Such interfaces have proven exceptionally reliable and the protocols for testing and defect diagnosis have avoided the dreaded “finger pointing” between software vendors.

Even more effective is using HL7 to support integrating software applications built on compatible operating systems and databases. In such an environment, software vendors can join their system at significantly reduced cost and risk while allowing each vendor to continue improving their proprietary offering without fear of impairing data flow or software functionality. Such an integration approach allows practices to select from a variety of software offerings with reduced risk of software failures. The practice thus gains an “enterprise solution” of superior software along with an increased ability to recover from a vendor’s decision to sunset an offering through business failure of acquisition.

Finally, software providers must decide whether their offerings should attempt to address a broad range of medical specialties or should focus on a relative few specialties. Generalized PM and EMR software can be developed with features allowing it to be tailored to specific specialties, but this approach will not serve any specific practice as well as a specialized offering. Software providers are also faced with the need to prioritize the many enhancement suggestions received from an increasingly sophisticated customer base. Many requests will be unique or of special importance to a specific specialty environment, and the ability to continually enhance software offerings requires to provider to maintain a consistent set of valuation criteria to establish priorities among the many competing enhancement requests.

(MedEvolve Trailer)

MedEvolve, Inc. is a privately held corporation formed in 1998 from a 15-year firm that developed a series of practice management systems on older technology. MedEvolve provides a three-tiered set of PM applications and EMR solutions on a Windows® and SQL® platform. MedEvolve continues to concentrate primarily on PM application enrichment while using HL7 standard interfaces with over fifty separate ancillary systems thereby creating an information portal under the control of the practice’s administrator.