The IT Anatomy of Medical Practices

Today’s medical office hums with the IT activity of many integrated applications. From the scheduling and claims processing at the front desk to the images in the X-ray lab, to the charting and e-scribing in the examination rooms, a medical practice now needs an IT professional to make sure it gets the most benefit out of every IT dollar.

Some group practices are large enough to employ their own IT staff. Solo and smaller offices though, rely on IT consultants with medical concentrations to procure, maintain, and perhaps host medical applications. We spoke with two such companies to learn what kinds of medical software programs are most commonly being adopted in American practices and to get some advice on deployment.

According to Will Collins, , IT services director at Comprehensive Physician Resources Inc., which provides medical billing and IT services for five practices in northern Virginia, “The staple applications of most physicians’ practices are electronic health records (EHR) and practice management (PM).”

In 2015, the U.S. Office of the National Coordinator (ONC) for Health IT reported that 78% of all office-based physicians – led by primary care doctors – used certified EHR. In fact, EHR typically forms the hub into which other applications fit. Out of this hub, the first among these “spokes” is practice management software, which typically includes patient scheduling, billing, time clock and payroll.

Clinicians also Weigh Cloud vs. On-site Server

Like business software in general, medical practice software is also taking part in the great cloud migration. Large, server-based EHR players usually charge large upfront fees for licensing, hardware, on-site support and training, in addition to monthly or quarterly fees. But other well-established names are coming out with cloud-based offerings as well.

Many new, smaller EHR entrants are cloud-only. According to Collins, “The smaller SaaS vendors do not normally have a big upfront charge since there is very little if any hardware involved. These solutions are normally paid for month to month out of operation profits.” Collins also notes that such applications don’t tend to come with much if any local support, relying instead on vendors’ own help desks to assist users by phone and remote desktop control.

In the long-term, cloud-based EHR software costs more than on-premise installation of similar breadth, says Julian Jacobsen of J.J. Micro LLC IT Consulting, which supports over 150 small medical and dental practices in the St. Louis, MO area. He only recommends cloud migration to a practice that is ready to invest in a significant EHR upgrade.

“If a practice is happy with its existing EHR and just wants to move to the cloud version, I don’t think the cost-to-benefit ratio is acceptable,” he says.  But, “If a practice is looking at changing to a completely different EHR – and understands the considerable costs of converting their database – that practice can spend relatively little more and move to the cloud at the same time.”

A greenfield deployment is another story. “A brand new practice should definitely consider cloud EHR if they have access to fast enough redundant Internet connections,” says Jacobsen. Backup connections can never be overlooked: “If you have a single Internet connection and it goes down, you can’t take care of your patients,” Jacobsen warns. “4G Internet backup or a secondary hardwired line from a different service provider are my usual recommendations.”

Jacobsen recommends cloud for typical email and office apps, and for server and workstation backup.

As one who performs risk assessments for medical and dental practices, Jacobsen also cautions physicians not to stint on HIPAA compliance measures. Although many doctors know that HIPAA compliance is critical, he notes that around 90% are not fully HIPAA compliant, and 50% to 75% are not compliant in at least one high-risk category, leaving themselves open to a breach. Doctors mistakenly assume they are only risking a modest fine, he says, but in fact, “It can run up hundreds of thousands of dollars supplying credit-monitoring services for those whose IDs have been stolen.”

Jacobsen reminds anyone responsible for healthcare IT to get signed Business Associate agreements (BAA) from their cloud providers; these establish their shared liability in HIPAA compliance audits.

Getting More out of EHR Systems

Collins and Jacobsen provided additional examples of apps that frequently draw from or update EHR data.
Imaging software is typically specific to the doctors’ specialty and generally runs on a workstation connected to an imaging device via USB or network connection. Sometimes this cataloging and archiving functionality is built into the EHR.

E-scribing is also built into the EHR, replacing the traditional (illegible) prescription pad. It updates the patient record as it transmits to the pharmacy. The ONC reported that in 2016, 70% of U.S. doctors were e-scribing through EHRs.

Speech-recognizing dictation apps enable doctors and nurses to speak notes directly into EHRs – the most well-known platform is Dragon Medical Practice. A more expensive option than the consumer version, Dragon Dictate, it comes loaded with medical recognition vocabularies and replaces third-party transcription services.

Patient portals let patients access their own health records and test results, communicate with doctors, set appointments, and pay bills. Typically offered as an EHR module, cloud vendors like Practice Fusion offer this functionality for standalone practices at a moderate price point.

As Collins sums it up, “These applications streamline the patient experience. Even the smallest factors such as pre-filled forms matter to patients who have been complaining about the process for years, and could mean the difference between a one-time and a lifetime patient.”

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