Once a hallmark of high-tech vision care, practice management software has become a staple of practice operations. But it’s important that your view (or use) of this tool does not become ho-hum. Practice management software is essential to appointment scheduling, recalls, chart documentation, frames/Rx orders, patient data, insurance billing, inventory management and practice financial reporting. And vendors of optometric-specific software (there are at least 40) promise new and improved versions that integrate with computerized instruments and frame barcoders, write and send referral reports, and even “talk” directly to your patients.

Considering the proliferation of new software products, it’s difficult for any practice owner or manager to be certain they have the best tool and are using it to its fullest potential. Take a few minutes to assess your current software and decide whether it’s time to investigate new options.

1. When was it updated? Generally speaking for technology, two years is a long time and four years is an eternity. However, this is more true of hardware than software, as software can be upgraded without any physical limitations. A computer you bought in 2000 might be considered ancient, but software that has been upgraded regularly may very well be current. That’s what Albert Pang, OD, thinks about the software he bought 14 years ago when he opened his Dallas practice. He first used the software mainly to track practice performance, but he has upgraded it annually and expanded its use.

“It was a DOS operating system and now we are in Windows. We use it to schedule appointments, prepare fee slips, maintain inventory, track patient orders, recalls and internal marketing,” he notes. Anthony Diecidue, OD, president of the Pennsylvania Optometric Association and a principal in Mountain Computer Systems, says software is “too old” when it cannot:
• Comply with HIPAA privacy standards
• Run on current systems such as Windows- XP
• Support new mandates such as the use of National Provider Identifiers (NPIs)

He notes that obsolescence is not the only reason to invest in new or upgraded software. “It’s worth it to add new features, whether they are required by third-party payers like Medicare or they are ‘convenience’ features that make your life easier.”

2. What does it do for the practice? There are certain “basics” that every software package should provide:
• Appointment scheduling
• Patient demographics
• Recall
• Billing and insurance claim submission
• Financial reporting
In addition, your software should enable efficiencies you couldn’t achieve without it.

“We could not function with one appointment book and multiple workstations,” says Carl Urbanski, OD, of Kingston, Pa.

“And there’s too much billing and insurance information to not be electronic.” He adds he’s a better practice manager thanks to financial reports to track statistics and patient account aging.

At the practice of Holton King, OD, near Atlanta, more sophisticated data reporting provided him with a major revelation.

“My perception was that my patients were 75 percent insurance or other third party billing. My data collection revealed that I was 70 percent cash paying. I never knew,” says Dr. King. In addition, the introduction of Electronic Medical Records (EMR) has saved paper and space. Dr. King will be converting his “records room” to a new insurance office/call center. He believes staff and patients appreciate the positive changes. “In general, the patients are impressed with computer usage and the consultations with computerized instruments. I know they love not having to fill out forms as they did before. With a few questions and the previous history in front of them, the technician takes a ‘comprehensive’ history, which is one of the key components of proper coding and billing,” he notes.

Daniel Kohansby, OD, a colleague who practices in Phillipsburg and Vernon, N.J., agrees: “I believe patients leave with the impression that they receive more advanced care because of the electronic environment. The staff is not fumbling around looking for paper records. Computers in every exam room give the impression of a ‘modern,’ technologically advanced office.”

3. What are the features that you don’t use? The answer to this question can point you toward options to explore before investing in an upgrade or new software.

“We have never used the frame inventory function,” admits Audra Seiber, OD, of Harrisburg, Pa. “We tried it about two years ago, and found it cumbersome to use. We don’t have a large inventory in this office, but we will double our frame capacity and stock a lot more contact lenses when we move into a larger office in January. We will be using the inventory function then and I expect it will be very helpful when it is up and running.”

Dr. Kohansby uses two different software packages (Eyebase and OfficeMate) in his two locations, due to the fact that he bought one location with the alternate software already in place. In both cases, there are features he does not use, such as an integrated credit card service, automated patient appointment confirmation and patient education videos.

“These features cost extra and are too much money for now, but they could be useful,” he notes.

In general, Dr. Diecidue notes, practice owners and managers should make full use of analytical tools. “Any type of practice analysis or financial reports should be utilized to glean information on the ‘health’ of the practice. Without these you are running a business in the dark.”

4. What features do you wish it had? Practitioners put automated referral letters, integration of data from automated instruments and a more robust accounting function (like Quick Books) at the top of their “wish list.”

“In my experience, every OD’s office has different needs. To some, bar-coding is paramount while in other offices, patient reports are. Still others want more flexibility in claims submission,” notes Dr. Diecidue.

Other new features promoted by software vendors include:
• Billing links to specific third party payors, such as VSP
• Capitation analysis/reporting
• RVU analysis
• Direct electronic claims submission
• Lens Rx manager that calculates lens cost based on the Rx power
• Detailed tracking of patient movement through the exam process
• Easier integration of patient demographics with medical records
• Dictation-enabled EMR
• Interacts with tablet PCs
• Integration with bar-coding technology
• Improved frame inventory reconciling
• Batch transmission of lab orders
• Links to online patient scheduling and autocalling features

Tech Support
Unless you are a computer whiz, you should budget for tech support. Those who have “been there” say you should hire a qualified technician to set up your network, maintain it and troubleshoot on an ongoing basis.
“I have seen more problem issues with ‘homegrown’ computer systems than with anything else. Having a savvy technician can make your life much more enjoyable when issues with your computer system occurs,” says Anthony Diecidue, OD, of Stroudsburg, Pa., and a principal in Mountain Computer Systems.
There are several ways to obtain tech support. Albert Pang, OD, hired a patient (who is qualified) as an independent IT contractor. He comes to Dr. Pang’s Dallas office whenever there is a network problem, software upgrade or installation of new hardware at a cost of $70 an hour. The typical cost for a year is $2,100.
If you don’t have an obvious source of this expertise, talk to colleagues and other business owners in your community. Most businesses need IT contractors for the same reasons you do. You can also look in the Yellow Pages, but always seek references and check them, because anyone can claim to be an “expert.”
You are looking for a computer consultant who will: •Properly set up your network
•Perform regular maintenance
•Install upgrades
•Troubleshoot any problems
• Be available during all business hours and have after-hours emergency service
In addition, most software vendors offer ongoing technical support for you and your staff. While this is not on-site and does not address network problems, it’s well worth it for operational peace of mind. Offered as online and/or phone support, it generally costs $600 to $1,000 annually depending on how many modules you have up and running.
5. The Big Kahuna: EMR. Practitioners who already have EMR can’t say enough about it, and experts insist everyone will need to have it soon.

“It’s a must-have,” asserts Dr. Seiber. “EMR means better documentation, eliminates illegible handwriting, fewer transcription errors, easy to do professional correspondence with auto-letter function. And don’t forget the patient ‘wow factor.’”

Clinicians say both staff and doctors will benefit. “Electronic Medical Records make finding charts a snap. Also it forces the doctor to complete the record at the time the patient is seen. Therefore you are not left with a supply of unfinished charts,” says Dr. Kohansby.

Most practice management software has some form of EMR available and doctors will not be able to avoid this change much longer.

“The number-one reason to convert is that President Bush has outlined a strategy for giving all Americans access to their records by the year 2014 or so. That means that if you don’t have EMR now, you will have to soon,” says Dr. Diecidue.

Those who took the plunge several years ago are reaping the benefits. Richard Edlow, OD, chair of the AOA’s Information and Data Committee and COO of the Katzen Eye Group in Towson, Md., says EMR has “transformed” the practice.

“Now we have been up and running [with EMR] since 2003. Our patient volume has increased at an annual rate of 15 percent without the need to add human resources. Several staff members have even shifted to other responsibilities. We no longer lose any charts. Calls for prescription refills are handled while the patient is on the phone. Billing denials are seen from a computer screen and immediately handled. Doctors can review patient records while on call from just about anywhere,” says Dr. Edlow.

If the transition to EMR is holding you back, those who have gone through it say it may not be as difficult as you think.

“How hard is it to integrate into practice operations? On a scale of one to 10, with 10 being impossible, maybe a three at worst,” says Dr. Seiber.

“I did not find it hard at all,” says Dr. Kohansby. “It did take staff some time to get used to the software and it did slow down exams for the first one to two weeks. But after that, it sped things up. There are colleagues of mine who want to slowly introduce EMR. I believe this is a mistake. Do it all at once and suffer with the headache only one time. After that, it’s smooth sailing.”

Like so many things in a practice, attitude affects outcome, says Dr. Diecidue. “It depends upon how receptive you and your staff are to change,” he says. “If you are resistant to change, it can be very difficult. Having a staff member or two that are technology-savvy will ease the transition.”

6. What would it cost to upgrade the package you have? Costs vary greatly, with the industry moving toward “pay as you go” strategies in which upgrades are free but the practitioner pays for the use of the software on a monthly, quarterly or yearly basis.

Leading software packages generally charge more than lesser-known (but, vendors claim, comparable) products. Dr. Urbanski says upgrading to EMR with his current software would cost $3,945, which includes the software license, online and phone training, and the annual support fee. But a practitioner who did not already own the software would have to pay closer to $7,000 for the software package and EMR module for use in an office like his (six to 10 workstations).

There are hidden costs to upgrading which can have a big impact on your budget. Dr. Urbanski says he would need to invest in a dedicated server, larger router, second battery backup, mirror hard drive, plus installation by his network support company. He’s been given a verbal estimate of $10,000 for that.

Data Backup
Always an important concern, make sure you are up-to-date with data backup. Storage is cheaper than it used to be and the old tape drives and backup software are obsolete. Here’s what colleagues are doing for backup:
• “My server has a mirror hard drive configuration as a back up. It came together with my server, they were about $700 all together, says Albert Pang, OD.
• “We backup onto an external 80GB hard drive (that stays at the office) and a 4GB USB thumb drive (that leaves with myself or the staff). The EHD was around $300 when we purchased it a couple years ago and the thumb drive I just purchased for about $100,” says Audra Seiber, OD.
• “We use a tape back-up with a data tape for each day. I take the most recent tape home with me each night so it’s off premises. We recently added a secondary back up offsite to a remote service called DataHealth. There was a one time setup fee of $125, then a monthly fee based on the amount of data backed-up. $30 per month for 1GB of compressed data and $20 additional per month for each additional GB of data. They access our server overnight and back it up,” says Carl Urbanski, OD.
• ”I recommend using CDs and USB key drives for backup purposes. These formats allow large amounts of data to be stored with no need to compress or encrypt. The data is in a usable format at all times and can be retrieved instantly. Both formats are commonplace on just about every computer and can be taken home conveniently,” says Anthony Diecidue, OD. He adds you can use your other networked computers for backup or contract with an online service to backup during the middle of the night.
7. How much can you invest in new software? Certainly an investment in new software will cost more than upgrading the one you have. Many practitioners have suffered “sticker shock” when shopping for new software.

“Software can be ridiculously expensive,” acknowledges Dr. Kohansby. “Software companies will tell you that you can’t put a value on increased efficiency or increased patient flow. If they have to give you that line, it’s probably too expensive.”

Some practitioners offer specific guidelines, such as $25,000 (over that will take too long to recoup on the bottom line) or 1 percent of gross collections. But Dr. Diecidue challenges you to think about the value to the practice.

“It all depends on your needs. You can buy a Toyota for around $15k or you can buy a BMW for $40k. They will both get you to your destination, but there are differences. Same with software,” he says.

He counsels ODs to think about the product features and ask themselves which ones they will use. If you won’t be using certain features now, it’s not worth paying for them now. Usually, you can add features later for a cost.

He believes that the purchase price is less important than the Total Cost of Ownership (TCO). “TCO encompasses not only the purchase price of the software, but other expenditures such as maintenance, training, technical support, licensing fees, software upgrades and hardware upgrades,” says Dr. Diecidue. “When interviewing vendors, ask about TCO and what your yearly expenses will be. Typical TCO includes the purchase price (or lease cost) and maintenance. Other costs may be optional, so you can choose what you need or can afford at the time.”

Editor's Note: While this article does not compare software packages one-on-one, an effort was made to research a cross-section of software products. For more information click here.

Judith Lee is an award-winning journalist who has been reporting on the eyecare industry since 1979. She is a regular contributor to several Jobson publications. Her web site is www.judithlee.net. LT