information technology
Bridging the Gap
The information you need to build a cutting-edge practice is already stored in your records. Here's how to find it and use it.
BY MICHELLE BOYLES, Managing Editor

On July 21, the U.S. Department of Health and Human Services declared the next ten years a Decade of Health Information Technology (HIT) and outlined a 10-year plan to transform the delivery of health care by building a new information infrastructure. This will include electronic health records and a network to link health records nationwide.

If the thought of going paperless scares you, you're not alone. This year's American Optometric Association New Technology Survey indicates about 79% of optometrists now file claims electronically, but only about 19% keep patient records on electronic files. This means the majority of O.D.s have a long way to go before reaching the goal of practicing electronically. While we are still years away from having electronic health records for every American, there are things you can do to prepare for the eventuality of a national EHR network.

Your first step should be to implement practice management software. While O.D.s were once relegated to making medically-oriented software work for them, a variety of packages are now tailored for use by optometrists. PM software can improve your practice by making better use of the data you're already collecting on your patients.

Improving patient communication

Do you often feel like promotional materials are wasted on your patients? Use the data collected on patient history forms to target your success in marketing efforts. This is where taking a careful history can really pay off. Let's say you want to alert your patients to a new dry eye treatment available in your office. PM software allows you to look at your patients' records or sort by ICD-9 diagnostic codes to determine which patients have a history or diagnosis of dry eye, or who have conditions or work in an environments that put them at increased risk for the condition. This is your target market for the dry eye promotion you want to send. Says John Scibal, O.D., of Morehead City, N.C., "Simply pull the subset of patients you want to target from your database and create a mailing list. Rather than print the labels ourselves, we save the mailing list to a file and e-mail it to our local print shop, where they can print the addresses directly on the brochure or newsletter."

This kind of operation can be put to use in almost any area of your practice. Optometrist Anthony Diecidue, of Stroudsburg, Pa., agrees that O.D.s miss many opportunities. "Pick out the high myopes in your practice to market ultra-thin lenses, or find your younger patient population to market the new sports-tinted contacts lenses," he says. And PM software can help you track the success of your marketing efforts.

Also consider communicating via the Web. "You can collect e-mail addresses right on the patient history form, then send out newsletters, information and appointment reminders via e-mail," he says. This is convenient for many patients who work on a computer all day.

Michael Rotholz, O.D., of Ontario, collects e-mail addresses when patients book their appointments. He then sends a virtual welcome brochure to new patients, or a "welcome-back" e-mail to returning patients. This software also creates a profile for each patient based on his or her diagnostic conditions and eye care interests. "With this information, I can e-mail prewritten and personalized articles to individual patients or to entire diagnostic groups," he says.

There are drawbacks to using this method of communication. Dr. Scibal points out a lot of patients don't notify O.D.s of changes in their e-mail addresses.

Organization

You can also use PM software to call patients prior to their appointments. Many packages automatically call patients the night before their appointment. What's more, Dr. Scibal's system prompts the patient to respond yes or no, instead of just leaving a message. This helps cut back on no-shows and last-minute rescheduling.

PM software can also help link the different areas of your office and keep staff members informed on a given patient's needs and restrictions. "During the exam, we generate a contact lens prescription with the expiration date. If the patient needs glasses, the prescription includes instructions on the type of lenses," he says. When the prescription is entered, the system generates the price for each lens. In the dispensary, frame prices are bar-coded so staff can easily calculate the cost of the final order.

At the end of the visit, the software calculates what the patient owes and batch-bills insurance companies at day's end. Dr. Scibal says they receive payment in a matter of days versus weeks. Dr. Diecidue's software package also includes a screening process for billing Medicare claims. "If you try to bill too high a level of coding, the system will prompt you to go back and make changes," he says. "It monitors what you're doing and advises whether you're doing it right." Optometrist Pamela Miller of Highland, Calif., explains, "Effective electronic implementation allows for a faster turn-around time for authorization of services, and improved coordination of the appeal process of any denied claim."

In addition to assisting with billing and coding, PM software can help you improve your office documentation. "Any paper that comes into the office is digitized, usually by high-speed scanning and a document management program that interfaces with our other software," says Dr. Scibal.

You can also quickly generate reports to send to referring doctors. "Record transmission allows for more rapid diagnostic and treatment alternatives ... The health care specialist is better able to consult with colleagues, keep everyone informed on the patient's care and interact with fellow health practitioners to better serve the patient's health needs," says Dr. Miller.

Staff matters

One big concern with implementing any new technology is the learning curve for staff. While many tech-savvy staff members may be able to pick-up new procedures quickly, others may be confused and reticent to accept major changes in the way things are done. "If you have five employees," says Dr. Diecidue, "there will be one who is resistant to change." The best way to nudge these staffers towards technological advancement is to get involved yourself.

Many O.D.s are themselves hesitant to use the technology. It can be tempting to delegate computer tasks to a single staff member. But this can cause headaches in the future. "Typically, one staff person is the key computer or electronic entry individual. When that person leaves, the entire learning process often starts over," says Dr. Miller, a member of the AOA Health Information Technology Study Group, formed to assess the potential impact of federally-mandated health information technology laws and policy on optometry.

You must take a hands-on approach to any technology. "I've seen people purchase $20,000 worth of software and do nothing but recalls with it. If the doctor buys into the technology, the staff will too," says Dr. Diecidue.

Ultimately, technology allows staff to focus on more valuable activities. "If a computer can do it better, people should be waiting on patients, instead of filing, counting, ordering or calling," says Dr. Scibal.

Cost

Another concern for many O.D.s is the cost of PM and EHR software. PM software can range in cost from $1,500 to $27,000. "If I was to set up my PM system today, the software would prob-ably run $30,000-$40,000, but I can't imagine how many employees it would take to do what the system does," says Dr. Scibal. "I've never upgraded any type of computer technology without a pay-off in productivity."

The AOA's presentation to the National Coordinator for Health Information Technology (NCHIT) addresses the issue of cost. The AOA strongly recommends the department of Health and Human Services (HHS) stipulate that financial incentives be given to EHR vendors (scalable to any size clinical practice) and that the costs reflect the size of the product. What's more, the Centers for Medicare and Medicaid Services (CMS) will provide doctors with an electronic health records software package, similar to a program used by the Veteran's Affairs Administration, at no charge.

"In the future, paper claims will not be the standard, they will actually cost you more," Dr. Diecidue points out.