Typewriters are long gone from the medical industry, as they are from most of the rest of the world. The new wave of software and Web-based applications for streamlining communication among practices, hospitals, third-party administrators, and even patients is in place to enhance practice management. Yet there are many vagaries to coming up with the best solutions for your practice needs.

Just 5 or so years ago, the idea of the paperless practice arose, with the thought that such a practice would be able to efficiently manage communications among the various stakeholders. The time has perhaps come to tally the pros and cons associated with the idea of a paperless office.

Let’s first establish what electronic communication can do. Through the use of computers (and the associated hardware, software, and Web-based applications), electronic communication offers a means to document, transmit, and store information—without paper. It sounds good, but even better, the possibilities offered by electronic communication seem to be endless:

  • patient record keeping;
  • imaging technology with morphing capability for before-and-after photos;
  • billing;
  • scheduling;
  • voice-recognition technology;
  • free-text entry capabilities to document changes in techniques and procedures;
  • informed-consent documents;
  • tickler reminders; and
  • e-mail communication.

The Push for Change

Even with all this, HIPAA regulations and third-party administrator requirements appear to be the driving force behind computer network installations. In addition, the requirement for some practices to increase the insurance-reimbursed portion of their businesses may have created a greater need for investing in a paperless system.

Today, it would appear that avoiding an even partially paperless office would be incomprehensible.

Yet the journey from paper to paperless is unique for every practice. There are many questions that need to be answered. John E. Sherman, MD, FACS, a plastic surgeon in New York City, started his practice with a typewriter and a notepad, and he ran it successfully without any problems. But he integrated electronics when third-party administrators stepped in with their requirements.

Sherman comments, “There is no question that I have witnessed the benefits of computer integration such as time efficiency and flexibility. I have no regrets, but sometimes I have to ask myself, ‘Am I running the computers, or are the computers running me?’ “

There are numerous reasons why medical practices would want to move to a computer network environment. First and foremost is the requirement to develop a more efficient system for records and billing, specifically for Health Care Financing Administration forms.

Easy access is another consideration. For many practices with more than one physician, managing communications without a networked system would be difficult at best. In fact, the ability to track every parameter of a busy practice is limited without the integration of computer systems.

A reduced storage-space requirement is another incentive for developing a computer-networked practice. Bruce E. Genter, MD, a general and plastic surgeon in Jenkintown, Pa, says, “The integration of computers offers better communication. The systems I use efficiently track patient information and encompass the consultation, operation reports, progress notes, dictations, and the use of morphing for presentations. I’m able to store information in the right format and archive data appropriately.”

Now, let’s explore some considerations concerning the transition from notepad to computer.

Quality Care

Quality care is the primary goal of every practice. Ideally, the capacity to address patient inquiries at a moment’s notice and to view every aspect of a patient’s records—providing enhanced personalized communication with the simple click of a mouse—is highly desirable for both patient and physician. The convenience of imaging software that has morphing capability helps to identify and set reasonable patient expectations.

The broad scope of options available to personalize forms and functions, including informed-consent forms that provide risk factors specific to the patient and the wealth of imaging choices for presenting variations in technique, can help strengthen the physician–patient bond.

Cost Savings

It may be difficult to quantify cost savings when we take into account the staff time required to scan patient records, install hardware, and integrate software programs into the practice. But undoubtedly, there are cost savings associated with computer networks in the office. As Genter observes, “Cost savings for storage space is significant.”

In fact, the ability to retrieve patient records at a moment’s notice compares well with the turnaround time associated with locating hard-copy files. Furthermore, the eventual reduced payroll expenses that occur in a fully integrated office may be quantified by determining the dollars formerly allocated to filing personnel, data-entry staff, and paperwork completion.

Another easy number to quantify for practices is the insurance-premium discount offered in some states for electronic conversions. For example, the State of Illinois mandates a 2% insurance-premium reduction for electronic conversions.


Time is a valuable commodity for any practice. The simplicity offered by electronic charting and billing features that allow multiple diagnostic codes, procedure variations, and flexible changes in fee schedules can significantly improve office efficiency. Other time savings include flawless and timely routine transfers from electronic patient records, histories, scheduling, and charting; and imaging technology that can create reproducible photographs to be archived in multiple categories for easy integration into marketing presentations.

Whether the efficiency is created for staff members or the physicians themselves, efficiency alone is a valid reason to purchase computer systems. Michael H. Rosenberg, MD, FACS, a White Plains, NY, plastic surgeon, asserts, “The ability of more than one staff member to be working with a patient’s chart, or of a physician to be able to dictate and work with his or her hands at the same time, provides great efficiency in the practice.”

Accessibility and Flexibility

On top of quality care, cost savings, and efficiency, a state-of-the-art electronic communication system offers easy access and portability of patient records. The surgeon, the anesthesiologist, the recovery-room personnel, and others have equal access to all the information in a networked structure. And physicians can address patient concerns from their laptops from anywhere there is Internet access.

The high number of procedure and technique choices available to patients in today’s ever-changing plastic surgery environment makes the practice’s need to keep up to date far greater than ever. Many software manufacturers very responsively provide updates that fulfill physicians’ continually changing needs.


Finally, the security factor that was once a major cause for concern—and may still be in some practices—has been well-enough resolved for others to invest in computer applications. Rosenberg says, “I felt comfortable investing in computers when the problem of confidentiality breach was solved to the satisfaction of the government. Of course, it is prudent to carefully select your vendors to help ensure patient privacy and safety from data loss that may result from computer crashes or otherwise.”

It is true that it is impossible to completely eliminate the possibility of a hacker attempting to break into your system, and computer crashes may be unavoidable. However, manufacturers have made great strides toward enhancing security and preventing data loss. For example, firewalls and intrusion-detection systems offered by some vendors can enhance security. Certain vendors can provide the security level offered to financial institutions. An intrusion-detection system permits an alert to be sent to the vendor’s IT personnel, who can in turn work to stop the intruder from entry.

A greater sense of security and peace of mind are now associated with electronic practice management. Plastic surgeon Hans Kuisle of Boulder, Colo, says, “I have a secure feeling knowing that I can track every perimeter of my practice through a computer. Also, the software plug-ins for patient forms may be tailored to specific patient needs, providing a more secure feeling that all interested parties are fully informed.

“For example, my informed-consent software forms automatically incorporate risk factors specific to the patient. This helps to make clear that the patient has made an informed decision.”

Is This Move for You?

Whereas many plastic surgeons have integrated some level of electronic communication into their practices, others have not found it necessary. Mark P. Solomon, MD, FACS, of Bala-Cynwyd, Pa, declares, “I have been fortunate that I have not been pushed into electronic records because of my exclusive elective-fee-for-service focus. By the same token, I utilize imaging technology because it truly enhances my practice.”

Perhaps one factor that makes Solomon atypical is that he is a sole practitioner. However, his other staff members, such as his aesthetician, use software to track information for ongoing patients. But Solomon’s strategy works well for him, because he manages to treat 50 to 75 surgical patients per week using a paper-based system. Solomon’s practice is one example of why a priority-features list, a long-term plan, and a budget are critical elements for deciding whether to adopt this 21st-century move.

Practices must identify priorities for the integration of electronic communication, including:

  • Which functions should be replaced?
  • Will the software application be compatible with existing software applications in the office?
  • What are the incompatibility issues?
  • What is the conversion process and time commitment for all parties?
  • What are typical stumbling blocks that can be encountered during conversion?
  • Is the software easy to use?
  • How much redundant data entry is required if the software is purchased?
  • What is the process and time commitment to convert and import paper charts into electronic forms?
  • How expansive does imaging technology need to be; morphing or no morphing?
  • Will the benefit of voice-recognition transcription provide the right turnaround time for the practice?
  • What are the hardware requirements?
  • What is the cost to add new features?
  • What are the installation and training costs?
  • What are the ongoing costs, and are these costs capped or discounted over time?
  • What software support is available?
  • In what ways is the software HIPAA compliant?
  • Is there an indemnity clause to protect the practice from possible litigation?
  • How much downtime may be associated with computer crashes, incompatibility issues, training requirements, and maximum capacity problems that require additional purchases?

Evaluating Practice Precautions

There are three primary areas for which practices should take precautions: security of information, allocating the right amount of funds for the purchase and ongoing support, and selecting the right vendor.

Numerous security precautions must be taken by a practice to protect its information, including:

  • using the same network, server, and e-mail software throughout the practice;
  • installing spam and virus protection;
  • setting up automatic alerts for staff members to change passwords on a regular basis;
  • backing up data on auxiliary hard drives or CDs; and
  • maintaining computers and keeping them clean—even dust can be responsible for a computer crash.

Other practices have taken measures to disclose the nuisances associated with computer technology and online communication. These precautions include written disclosures and agreements between the practice and patient that can be completed online or in the office

Costs after the purchase of electronic systems for communication must be critically evaluated. Software upgrades may require additional costs. Maintenance costs may occur over time. Technical support may be required, and the level of support may vary among providers.

There is a difference between hardware and software support. For example, there is “user technical support” to address simple issues related to the basic knowledge of using the product. And there may be numerous levels of support required by a practice to address troubleshooting “kinks,” incompatibility, or conversion issues—which may include hardware support.

Face-to-face support by local hardware vendors may be necessary. Communication for software support may be conducted via e-mail or over the phone, 24 hours per day. In some cases, the tech support rep can actually view your computer screen while you are, offering more efficiency in diagnosis and resolution.

Vendor selection is at the root of the decision to integrate electronic communication. It is important for practice personnel to investigate the vendor before making a purchase.

Investigations may be made by

  • attending product demonstrations at professional meetings;
  • securing references from other practices with goals similar to those of your practice; and
  • receiving feedback about the product from everyone in the office who will be using the product.
See also “The EMR Master” by Rich Smith in the April 2007 issue of PSP.

Many options are available today for turning your practice into a streamlined state-of-the-art electronic office. But you need a system that works for your particular situation. Of course, your patients will value the modern conveniences you can provide, and your staff members will realize the benefits of a tech-savvy office.

At the same time, the integration of electronic communication is a huge decision, and you must be in charge. In the end, the decision about the right vendor is a key component of setting your electronic communication strategy. The right decision will result in heightened efficiency and leveraged accessibility with better security options than were available in years past.

Lesley Ranft is a contributing writer for  Plastic Surgery Products. For additional information, please contact [email protected].