Our office recently made the transition from paper notes and an outside billing service to electronic health records and "in-house" billing. Once you make the decision to go "electronic," there are many things to consider as you transition. The most important consideration, of course, is cost. Can you truly afford all the miscellaneous costs that come with full implementation of a new system? Consider the following list of necessary items that you will need to make it all work:
Software program: There are many to choose from and you can easily spend up to $20,000 on a comprehensive system.
Server: Each software program has specific requirements for the server. Some software companies will sell you a server with the software package and typically the server will already have the program downloaded.
Computer(s): Each software program has specific computer hardware requirements that are fairly standard.
Hardware system installation: If you are not extraordinarily computer literate, then you are going to need to obtain at least three quotes for the hardware system to support the software program you choose. You need to make sure that the company installing your network system utilizes high-quality parts. Each computer will need a power backup. Make sure the installation includes carpentry work and painting as needed. You want to make sure you use Cat 5 wire for the cable runs.
Monitor(s): This usually comes with the computer unless you want something specialized, such as flat panel/screen, touch screen or wide panel/screen.
Mouse: Usually comes with the computer unless you want a wireless mouse.
Keyboard: Comes with the computer unless you want a wireless keyboard.
Mounting hardware: You will want good-quality mounting hardware for the monitor and computer in your treatment rooms. This is part of your system installation, but you need to make sure the company is very clear on exactly how they are going to mount the computers and monitors. A standard monitor wall mount with adjustable arm can cost $129.
Printers: Even though your goal is to go paperless, you will still often need a printer.
Check-in method (e.g., signature pad, finger print scanner, bar code scanner, magnetic strip card reader, pin code key pad): We presently still utilize a sign-in sheet, but you can set it up so your patients sign in with an electronic signature pad or other non-paper method. Each software program utilizes a specific model for the sign-in method you choose and you must make sure you buy the correct model for your software program. This is a classic example of additional cost that is easily overlooked, especially by the software salesman.
Camera: If you choose to have a photo of your patient in the system, then you will need to purchase a digital camera that is compatible with the program.
Scanner: Most software programs utilize a specific scanner model. Scanning is not as easy as it sounds, and you are going to want to minimize the amount of scanning that you do. You have to keep the old records for at least five years anyway.
Dictation software: You may choose to utilize dictation software for the notes portion of your electronic health records. In our opinion, most voice-activated systems simply do not work very well and we do not recommend using one unless you are already proficient with it.
External backup system: You will want to consult with your IT person on this, but you will need to have an external backup for your server. You can also have off-site backup or remote backup for a monthly fee. We have both.
Hardware maintenance/service plan: Typically the company that sells you the computer hardware will offer a maintenance plan for your system. They will charge a monthly fee based upon the number of computers, printers, scanners, etc.
Annual software maintenance/update fee: Whomever you choose will charge an annual update fee after the first year.
Internet service monthly fee: You will probably want high-speed Internet access, and this varies in price depending on the provider you use.
Conversion fee: Your software company can "convert" your old patient demographics into the new system for a significant fee. Obviously, if you are just starting in practice, this wouldn't be necessary.
Training: You will need to plan on spending some serious time on staff and doctor training. You must be prepared to pay for the extra time involved in learning the system. You will want to make sure more than one person in your office really knows the system inside and out, and you need to be ready to pay for the time necessary to learn it well.
Ideally, you would assign specific areas to specific people. For example, one doctor may be in charge of making sure that they know everything about the provider side of the software. There is a tremendous amount of work involved with any program regarding the doctor's chart note macros. Macros are sentences or paragraphs that save time by allowing the doctor to click or use a key word to produce it. The billing side of any program requires hours of training and learning.
We recommend that two or more staff members become highly proficient in the billing portion. We also recommend that you try to have one person who manages the system hardware breakdowns and repairs that are inevitable.
Additional training: After an initial training period, your software program company will begin charging for additional training service if you haven't learned the system in the time frame they allow for.
Additional staff: If you are currently not billing in-house, you will need additional staff for the extra work involved with billing.
Electronic billing clearinghouse: This is required for efficient electronic billing.
Virus protection: You will need some type of anti-virus software, which is usually extra.
Going live with an electronic health records system is not easy and is quite expensive. Most of the hard costs (computers, server, software package, installation, etc.) can be financed through a lease, but the soft costs (training, maintenance fees, updates, conversion, etc.) cannot be financed through a lease; you must be prepared to absorb these additional expenses. However, in the long run, assuming you are prepared for a significant financial commitment, going electronic is the right thing to do. The health care world is going electronic and all of us will need to join the inevitable march toward electronic health records.
Dr. Mark King graduated from Life Chiropractic College in 1986. He is a clinician at Mt. Lookout Chiropractic Sports & Injury Center in Cincinnati; president and lead instructor of the Motion Palpation Institute; and a coach and co-founder of Cutting Edge Chiropractic Consultants.
Dr. Steve King is a 1996 graduate of Life Chiropractic College. He is a coach and co-founder of Cutting Edge Chiropractic Consultants and has provided consulting services for several companies including Proctor & Gamble and the Cincinnati Bengals professional football team.