The array of medical practice-management systems seems to expand every day, with more powerful, more sophisticated options than ever before—including new specialty versions that are designed for plastic surgery practices. The vast assortment of features can make your head spin—but it is possible to sort through them all and find a software solution that’s right for you.

Medical practice-management systems are computer software packages designed to automate medical office functions such as appointment scheduling, billing, insurance claims processing, inventory control, payroll, and reporting. The latest systems are integrated with detailed client data and can dramatically improve office efficiency and workflow, saving both time and money.

Practice-management systems are designed to operate on one of four platforms: desktop, client-server, Web-based, or hybrid.

1) Desktop systems typically reside on a personal computer system that is shared by your staff. All software and patient records are maintained on-site in the office computer. Up-front and ongoing costs are typically very reasonable.

2) Client-server systems require the lease or purchase of computer server hardware and individual workstations or networked PCs. Typically used in larger practice settings, client-server systems provide multiple users with simultaneous access and file-sharing capabilities. Software, files, and patient records are stored on-site. A larger up-front investment is required for hardware and software, but ongoing costs (eg, monthly fees) may be lower.

All medical practice systems must meet certain standards to satisfy HIPAA patient-privacy and data-security requirements.

With desktop and client-server systems, technologies needed to install and maintain these standards, as well as to perform system backups, can be complex. You may need assistance from the vendor or a consultant. However, there are some benefits to using in-house systems, including increased control over your data and higher processing speeds.

3) Web-based systems, also known as application service provider systems (ASPs), are remotely accessed by your office-based computer(s) via an Internet connection. Software, files, and electronic patient records are securely stored off-site by the ASP provider; these files can be retrieved (viewed or downloaded) via the Internet.

The up-front hardware investment for Web-based systems is lower—notably, the cost of desktop PCs and a fast Internet connection—but ongoing costs (monthly fees) for the use of Web-based system are usually higher.

4) “Hybrid” practice-management systems combine both desktop and online approaches. A portion of the software needed to run the system is loaded onto and run from the office computer system, which is used to access other data on the vendor’s database via an Internet connection. The costs are variable—usually, they include both an up-front investment and a monthly access fee.

Many practice-management systems can be customized to some degree and can be integrated with existing software systems. Some are scalable—that is, designed to grow with the practice through the addition of new application modules or upgrades as needed. The newer practice-management systems come bundled with sophisticated specialty features never available before—such as the ability to “sync” with handheld PDA devices or smartphones, or to upload digital audio files, eliminating the need for medical transcription. Even with all these incentives and new options, in these uncertain economic times you might be asking: Is it really time to change our office operations or invest in new software? The answer may surprise you.


There are a number of reasons why now is the perfect time to evaluate and implement practice-management software or upgrade your system to take advantage of new features or options. These considerations include the following:

  • Improved staff productivity and streamlined billing/business operations—Perhaps the most important benefit of practice-management software is the improved efficiency of operations and staff productivity it can produce. No more pulling and replacing paper files or interpreting terrible penmanship. Everything is input directly to the system via screen and keyboard. With a few clicks, a bill is generated, a payment is logged, and the next appointment is confirmed.

Most practices experience a reduction in billing errors shortly after implementation. Practices that regularly work with insurers experience faster claims processing. The difference can be significant—a 2-week turnaround for an electronic claim versus a month or longer for a paper claim. For physicians who recognize a need to ramp up office productivity and cut costs, practice-management software is a worthwhile investment.

  • Compliance with HIPAA—The need to meet HIPAA requirements can be a powerful impetus for physicians to purchase new practice-management software or upgrade their current system. Many older versions cannot meet these federally mandated privacy and security standards, and most new systems have built-in HIPAA compliance.
  • Implementation of electronic health/medical records (EHR/EMRs)—By 2014, all US citizens will have a personal health record, and many medical practices are upgrading their systems to incorporate this new technology requirement.

EMR systems provide convenience, efficiency, and cost savings for busy practices, including multimedia storage of before-and-after photos, treatment plans, medical transcription files, and patients’ medication allergies.

  • Enhanced, automated marketing tools—Effective marketing is an important survival skill for medical aesthetics practices. The current generation of practice-management systems includes a variety of automated tools to help with sales and marketing efforts, such as mass mailing modules, the ability to capture referrals from patients and other physicians, tracking return on investment on advertising and outreach, analysis of retention and patient return rates, and tracking marketing productivity.

The latest “bells and whistles” may include particular features that you want to install in order to accommodate a regulatory requirement, operational need, or marketing strategy.

Many practice-management systems are highly specialized, offering customized templates, forms, and applications for plastic and cosmetic surgery, dermatology, medical aesthetics, and medical spas. Options include the following:

  • Automated cost quotation development for elective surgeries;
  • Elective surgery billing and financing plans;
  • Retail billing and product inventory tracking for skin care or other cosmetic products;
  • Bar code scanning for retail product sales; and
  • Web-based patient portals that include a shopping cart feature.


Many physicians elect to work with a consultant who conducts a “needs assessment” and assists in a new technology acquisition or upgrade. As with other software systems, practice-management packages should be selected based on a careful examination of several key factors.

Purpose and function. In order to avoid getting “lost at sea” among all the enticing new features that are available, be clear in identifying your reasons for investing time and money in a new system or upgrade. Competition among software vendors is stiff, and some vendors will promise you the world or make outrageous claims about what their products will do for you (“Eliminate no-shows forever!”). No doubt you will see through these claims; even so, it always helps to have your shopping list filled out before you go to the store.

Check Them Out Online

A good way to get familiar with practice-management system features and vendors is to do some research online. Order a free sample CD or run a quick demo on the vendor’s Web site, and take the software for a trial spin. This closer look will give you a head start in selecting the system and features that are most important to you. The following vendors currently offer specialized practice-management software for cosmetic/plastic surgery and medical aesthetics practices:

CosmetiSoft (

Brickell Research (


Patient|NOW (

DoxCity Medical Office Management Software (

If your primary goal is to modernize your billing function and implement EMRs, this is the place to begin. Other important issues and priorities may be revealed as you go through the evaluation—but without a clear objective in mind, you may lose focus.

Questions to ask: What do we need to accomplish, and in what order of importance? What specific problem(s) do we hope to solve with new software?

As part of this process, it may help to make a basic inventory of your current office operations and systems—what’s automated versus manual, and what’s working well for the staff and what isn’t.

It is extremely unwise to conduct this evaluation in a vacuum. Be sure to involve all staff in the process—from clinicians to reception staff to your “back office” operations team. These are your key “opinion leaders” when it comes to office operations and productivity, and their opinions are crucial.

System size. When it comes to practice-management systems, it seems that size matters. If the system you select does not have appropriate functionality or features, it won’t enhance efficiency but instead will become a bottleneck for patients and staff as they wait for their turn to schedule appointments, enter or retrieve data, or process bills or payments. If the system is too large, capacity will be wasted and benefits won’t balance with the cost of purchasing and implementing the system.

Be sure to choose a system that will allow you to expand its functions and capacities. This is particularly important in case you are planning to hire new staff or expand operations in the next year or two.

Questions to ask: How many people will use the system (for what purpose, at any given time during the day)? What will change in 1 year? Two years?

Technical sophistication and savvy. Not every member of your staff will acquire a high level of comfort or expertise with computers and information technology.

When selecting a practice-management system, try to match user-friendliness and level of complexity with the skill level of the primary user(s). For example, if your billing manager moonlights as a NASA software engineer, it’s probable that she will catch on fairly quickly to a new billing system. If your receptionist struggles with the concept of double-clicking, however, then appointment scheduling and other front-desk functions need to be user-friendly and intuitive in the extreme. In addition, training and customer service will be a high priority.

Questions to ask: How much time and training is needed for staff to become fully functional in performing their regular tasks? Is there an additional cost for ongoing staff training or customer support? How is it delivered—in person, online, over the phone? How are costs incurred, eg, an hourly rate? How much?

Investment/cost. Systems come in all price ranges and some may be out of your cost range, regardless of how much they will improve office operations.

Questions to ask: How much can I afford to spend—in both the short and long term—for the functions and features we need? And what is the cost of making no change at all? Are there unseen costs associated with maintaining our office system as it is currently configured?

One way to approach this is to create a checklist of features and benefits and rate each available option by its order of importance to you and your staff.

Some system features will be “must-have” functions, and others will be “wish list” items or fall into a category of less critical need. Examining each feature independently in this way may help to narrow the focus of your vendor search. The Feature/Benefit Priority Planner (Page 33) provides a sample assessment.


The practice-management system you select will involve a significant investment of time, staff training, and money. Once you have determined the level of functionality and service that you need, it is important to choose a vendor with the staying power to serve those needs well into the future.

See also “Tracking Your Patients” by Tor Valenza in the November 2005 issue of PSP.

Look for vendors that are financially stable (with a large customer base in your geographic area) and have a good reputation for customer service. One highly recommended method for evaluating vendors is to talk directly with one or two of its current customers, or conduct a site visit to see the system in action.

Most vendors will provide you with contact information for current clients in practice settings similar to yours. Take the time to talk with them about the software-installation process, any downtime that occurred, customer support, training, and their overall experience with the vendor.

The variety, functionality, and power of specialty practice-management systems are very impressive. The ultimate goal of all these systems is improved customer satisfaction and patient confidence, which comes—at least in part—from sustaining your practice at the “cutting edge” of technology. How sharp that edge should be is up to you—it’s rooted in the unique characteristics of your practice and your immediate goals and priorities.

Cheryl Whitman is an author, speaker, and beauty industry consultant for more than 30 years. She can be reached at (877) SPA-MEDI or