How to make the transition that will make your practice more efficient and profitable

The idea behind paperless office systems is to allow practices to efficiently manage communication among physicians, third-party administrators, billers, front desk staff, and even patients. The idea of seamless communication over server airwaves is exciting—but first, let’s clear this up: What does “paperless” mean, exactly?

Let’s take it from its origins. As you might expect, a paperless office is one that does not require the use of paper due to the use of computers and other electronic mediums to document, transmit, and warehouse information. Sounds good, right?

Of course, no office can be completely paperless—after all, we can’t stop people from sending mail. Still, in medicine, “paperless technology” can be used for patient record-keeping, digital imaging, billing, scheduling, and email communication.

Paperless: the New Generation

At least 1 decade after the introduction of paperless communication to the medical industry, the movement is in the midst of a reform. The crux of this reform is due, in part, to the public service sector’s push to deliver quick, efficient, and highly educational service to its consumers. Also, Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations and third-party-administrator requirements have helped bolster the move toward a paperless medical industry. In fact, 96% of the respondents in the 15th Annual Healthcare Information and Management Systems Society (HIMSS) survey of chief information officer (CIO) trends have adopted high-speed networks, a good indication that technology is moving at a rapid speed. Perhaps more importantly, though, the push for paperless office systems has come from physicians themselves, who have demanded more effective and user-friendly paperless technology applications that can potentially produce a strong return on investment (ROI). With the multitude of modern software products available, including voice-recognition and imaging technology, software modules that bridge the information gap from one application to another, or the “one-stop-shopping” programs, a paperless future may be nearer than we think. Yet, the journey from paper to paperless is a serious one. Let’s tackle some of the major issues surrounding the transition.

Why Upgrade Now?

Martin Moskovitz, MD, FACS Image Plastic Surgery, Paramus, NJ
In 2004, I began private practice and chose to create an office with 21st-century technology. My patients receive a much greater understanding of their surgery through imaging technology. I use my PC tablet to conduct consultations with the benefit of the entire patient history in view. In fact, patient charts are readily available for everyone in the practice. In the future, I plan to have my operating room, anesthesiology, and recovery room data input directly into my patient-management system to prevent misfiling or loss. I’ll also have a Web-based patient-intake form to provide the highest level of efficiency.
Steven Carp, MD, FACS
Carp Cosmetic Surgery Center, Green, Ohio

Over 7 years ago, I began to invest in software for the economic advantage of freed-up time and, ultimately, the forced issue relating to HIPAA. Until there are standardized forms, I’ve decided to build a long-term plan with the goal to be the most cost-effective solution and a focus on reliability.
Jennifer Butterfield, MD
Medical Director for The Women’s Plastic Surgery Centre Inc, Cincinnati

I needed a system that could expand with the growing needs of my practice. Electronic billing with the ability to generate HCFA forms has cut down on redundant date entry. I can also dictate all office notes with a digital recorder that connects to my computer to upload recordings that are transcribed within 72 hours and delivered to the appropriate patient chart in my database. Although we are still in the time-consuming process of converting our paper charts into electronic forms, we look forward to the day when we are a paperless office!
Loren S. Schechter, MD
Skokie, Ill

Electronic records were the drive behind the change. It was difficult to find a system that could assist with all operational functions, from practice management to digital imaging to marketing. In fact, not every procedure is a cookbook procedure. The system I use allows for free text entries with an interface that offers an easy-to-use language, similar to Windows. I have redundancy in backup. The up-front 2% cost savings in my insurance premium was a great incentive, and the soft savings achieved by reduced dual data entry is a valuable benefit. Clearly, this is a great evolution for my practice.
Verne Weisberg, MD, FACS
Plastic Surgery Center PA, Portland, Me

I needed to improve my software technology to provide all practice functions through electronic communication. I also wanted more technical support from my provider. Now, I’ve witnessed firsthand the benefits of financial tracking, sourcing, and excellent reporting tools.
Donna Zabojnik, office manager; Sam T. Hamra, MD; and Ramsey J. Choucair, MD; Dallas
The greatest asset has been the minimized manpower hours, with our software being so simple to use and [offering] excellent support. We are the first line to address patient needs. Now we can focus much more time on patient satisfaction and marketing to achieve greater revenue for the practice.

There are numerous reasons why medical practices would want to move to a 21st-century paperless practice. First and foremost is the need to develop a more efficient system for records and billing, specifically for Health Care Financing Administration (HCFA) forms. For many practices, the current system is outdated or no longer available; and the software upgrade modules are cost-prohibitive. Software support and technically savvy practice staff members may be an issue, especially if the current provider is unable to meet the appropriate level of support or user demands specific to the practice. The goal of new software is to improve efficiency and provide better patient tracking and financial reporting, thereby providing a higher ROI.

With information at your fingertips, reduced storage costs, lowered payroll costs, and higher patient-satisfaction levels, the list of reasons to purchase new software can be long.

How Will Going Paperless Save You Money?

Ideally, the end result of a paperless office will be increased efficiency, improved quality of care, and, ultimately, a positive impact on a practice’s revenue.

One easy number to quantify for practices is the insurance premium discount. In the state of Illinois, practices receive a 2% insurance-premium reduction for electronic conversions. Other states may have such incentives available as well.

The cost savings for storage space can also be significant. A server room requires much less space than a storage facility for patient records. Also, charts on a server can be brought up in less than 1 minute, as opposed to a 24–48-hour response time to retrieve old charts. And no more lost or misplaced files!

Going paperless may actually reduce a practice’s staffing requirements. Your office can eliminate time-consuming tasks like travel to off-site storage facilities, redundant data entry between software applications, and filing folders. Even more time can be saved by scanning external documents to provide a seamless entry into the practice’s database and having patients complete electronic record forms through the practice’s Web site, which can then be downloaded into the practice’s database.

According to the HIMSS survey, trends in health care technology indicate that the top three business issues facing the health care industry are reducing medical errors, cost pressures, and patient satisfaction. Today’s software can potentially alleviate such strains. The simplicity of electronic billing features that provide for three to four payors, and multiple diagnostic codes and fee schedules, can significantly increase office efficiency. This might also include seamless computerized routing of the patient record, history, scheduling, and charting, integrated with a practice’s marketing campaign to produce patient brochures and conduct email communications. In addition, digital imaging can produce standard photographs that can be reproduced and archived in multiple categories and be integrated into PowerPoint presentations. In fact, physicians can often address patient concerns from their laptops at home (or anywhere), anytime. Practices have also discovered that their new software can be easily integrated with other document formats, allowing them to escape being locked into any proprietary software.

Will the Patients Like It?

Increased patient satisfaction often leads to more word-of-mouth referrals and greater revenue. Simply put, the ability to address patient inquiries at a moment’s notice and to view a patient’s records from top to bottom with the simple click of a mouse is highly desirable for both patient and physician. The patient’s ability to complete a medical history form online can offer a great convenience. And an interactive video between physician and patient on a Web site can strengthen the physician-patient bond. Add to this the ability to conduct online consultations and appointment scheduling, and to keep in touch with patients via email. In fact, according to Jupiter Research, 63% of consumers say they would switch health care providers if they found credible content, email communications, or scheduling online. So, demonstrating your understanding of patient needs, coupled with a tech-savvy office, can only create a win-win solution.

With all these positives, paperless technology is a great move for any practice—as long as you research and select your software systems with caution and business acumen.

How Do You Choose a Vendor?

There are many ways to choose your technology vendor. Attending annual meetings held by organizations so that you can receive a hands-on demonstration of various software applications to rate user-friendliness can help you make the right software choice. With all the primary vendors at your disposal, a medical office can compare the costs and weigh the benefits of each system. Because various staff members will be using the technology, it is important to receive feedback on software demonstrations from everyone in the practice who will be using the software.

Don’t underestimate the importance of references. References can be provided by the vendors themselves, or they may be obtained by posting an inquiry on organizations’ message boards. In this inquiry, it might be helpful to cite specifics about the practice, including its size, current level of paperless integration, current technology specifications, and focus (whether it is reimbursed medicine and/or cash pay).

What Features Do You Need?

A prioritized list of features and a budget are equally important. In fact, a long-term plan may be the most appropriate, since standardized forms between hospitals, labs, and practices do not exist today. Based on this analysis, you can address the following other concerns:

• Is it necessary for the software to replace all technology functions in the office, or is it better to replace only certain functions now?

• Will the new software application be compatible with existing software applications in the office?

• What are the typical incompatibility issues?

• What is the conversion process and time commitment for all parties?

• What are the typical stumbling blocks that can be encountered during the conversion?

• What has been the experience of the quality of conversion from your specific technology to another software application?

• Is the software easy to navigate?

• How much redundant data entry is required if the software is purchased?

• What is the process and time commitment to import paper charts and convert them into electronic forms?

• Based on your practice’s focus, how expansive does imaging technology need to be?

• Will voice-recognition transcription technology be a better value than a human transcriptionist?

• What are the computer hardware requirements?

• Will the new system work with the current hardware?

• What is the cost to add new features?

• What are the installation and training costs?

• What kind of software support is available?

• In what ways is the software HIPAA-compliant?

• Is there an indemnity clause to protect the practice from possible litigation?

• Are there software upgrades required for possible HIPAA updates, and is there a charge or discount available?

As Allison Suren, healthcare attorney for Arent Fox, PLLC, of Washington, advises, “A company’s interpretation of their degree of HIPAA compliancy may vary between software providers. It is important for the software company to articulate the details of their assurances in meeting the April [2005] HIPAA security-compliancy deadline. The health care provider does not want to be at risk of being found noncompliant by the government.”

What About Tech Support?

The evaluation of technical support and ongoing costs is also significant. Support and upgrade pricing can vary among the many software providers. There can be a big difference between the level of support offered and the pricing associated with this support. For example, there is “user technical support” to address simple issues relating to the basic knowledge of how to use the product. There may be numerous levels of support required in a practice to address troubleshooting kinks, or incompatibility or conversion issues—which may include hardware support.

The form of support is also important. Face-to-face support by local hardware vendors may be necessary. Communication for software support may be conducted via email or over the phone, 24 hours a day. In some cases, the tech support rep can actually view your computer screen at the same time you are, offering more efficiency in diagnosis and resolution.

Final Thoughts

There are many options available today for turning your practice into a paperless, streamlined machine. At the end of the day, though, you need a system that works for your particular brand of medicine. Whatever software system you end up choosing, it can go a long way toward helping your bottom line. Patients will appreciate the modern conveniences you can provide, and they should return the favor with more referrals to your practice. Your own office staff will be able to go to their desktops for all of their needs and answers. And perhaps the most efficiency-boosting aspect of going paperless is that there will be less clutter and mess. In this busy and hectic world, less mess can be worth a lot more than the paper it’s printed on! n

Leslie Ranft is a freelance writer and independent public relations consultant for businesses in the health care and technology industries. She can be contacted at [email protected].