Whether you are a physician, a psychologist, an occupational therapist, another type of health professional or an administrator, the complexity of managing your office and vital patient functions tends to go hand in hand with the diversity of your practice model. That applies especially to multidisciplinary practices and those assessing or treating patients covered under more than one plan or program.

In the multi-faceted world of health services delivery, secure automation of “front clinic” and “back office” processes has never assumed greater importance. That is where practice management software can either help you or hinder you. When purchasing and implementing practice management software (PMS), you will be doing far more than simply loading a disk in your DVD tray and clicking the install icon. Furthermore, when you make the decision to purchase one product over another, you will reap what you sow in terms of patient management, productivity, compliance and financial management. To use what is perhaps a clumsy analogy, a little analysis and pre-planning will ensure that your harvest is weed free.

The PMS world is a crowded one. Claims abound as to products’ functional integration, automation, performance, pre/post installation support and technology compatibility. Truth be told, unless you have the scale and resources to build your own, the software you adopt will necessarily be a compromise among competing factors. If the lowest cost is your driving criterion, you may be trading off support, performance, integration or the automation of a critical process or function. That is not a bad thing as long as the trade-off is a conscious one based on sound assumptions about your needs.Whether they are large or small, public or private sector, every health practice contemplating making a PMS purchase should conduct a well-considered analysis of requirements. This rule applies whether you are going to build your own system or buy a package from a system vendor. Knowing what you need in objective terms will ensure that your purchase is an informed one. Make the purchase based solely on a gut feeling or the allure of the vendor’s claims for his or her product and you will pay a big price in practice disruption and crisis management.

In this article, we provide a simple step-by-step approach to determining your requirements. However, we would advise that “enterprise scale” practices of 200 or more staff should engage a competent IT professional who has experience with a conventional systems development methodology.

Step One: Define your facility’s current patients and clients

Perhaps it is human nature, but many clinics describe their patients in program or funding source terms: he or she is an “LTD,” “OHIP,” “auto insurance” or “WSIB” patient or client. Though it is critical from a management perspective to know where your patients or clients are coming from and to master the procedures you might have to follow when making treatment recommendations to third parties, or billing for your services, let’s agree that a patient is first and foremost a unique person. And persons have names, genders, conditions, medical histories, relatives and locations. It sounds pathetically simple, but we need to state the obvious sometimes because we lose sight of it.

All types of PMS allow you to record client information somewhere or other. In a requirements definition context, though, the key message at the outset is that the patient as a person is a distinct entity that is independent of any program, funding source, invoicing procedure or referral source. Purchase a system that ties the definition of patient to any of those other entities, processes or functions and you will have inadvertently chosen a path that has a dead end and no means of returning to “GO.” Canoeists refer to this condition as being up a creek without a paddle.

Step Two: “Map” your patient relationships in functional terms

Find yourself a flip chart. Draw a stick person or circle in the middle of it, then draw eight radiating arrows away from it and write the following headings at the ends of the arrows, one for each arrow.

• Providers
• Scheduling
• Goods, Services and Fees
• Referral Sources
• Documentation
• Service Activity
• Payers
• Management Reporting

Step Three: Draw arrows from your headings to sub-headings

Do this for each of the headings in a way that defines the headings. For example, Goods, Services and Fees sub-headings could be Assessments, Tests, Devices/Appliances, and Fee Schedules. Payer sub-headings could be Patient Pay, Insurer EHC, and Legal. Notes, Reports, Correspondence, and Forms could be Documentation sub-headings and Service Activity sub-headings could be Time Units, Service Units, Dates, and CCI Codes.

Either beside or inside the stick person or your circle list all the information that defines “patient” or “client” that does not already fall under any of the headings above.

Step Four: Under each functional heading or sub-heading, list different types

System data analysts call these “instances.” We’ll just call them examples. When listing them, don’t limit yourself by the typical patient or your own experiences alone; rather, list all the possibilities based on your current practice model. Think globally, generically and objectively.

Under Providers, for example, list the practitioner types (e.g. MDs, OTs, Vocational Consultants) and other staff roles that could have a direct interaction with a patient, such as Referral Intake Coordinator. In addition, under the Provider heading only, place the letter I (for Internal) beside the types that are formally employed by your practice, either full or part-time, and an E (for External) beside those that are external to your practice but perform services for your clinic’s patients on your clinic’s behalf.

Under Management reporting, start with “Patient listing,” “Services performed,” “Services- performed-but-unbilled listing” and “Aged receivables listing.”

Step Five: On a new sheet, map “objects” to your basic business processes

Create a ring of evenly spaced circles and label them as follows:

• referral sources
• patients/clients
• appliance/device suppliers
• payers
• sub-contracted staff or service providers
• one circle each for external systems with which you must interface for transactional or document transmission purposes, such as HCAI, WSIB, OHIP

Then draw a circle in the middle of the ring and label it “practice hub” or “clinic hub.”

Draw lines between the inner circle and the outer circles to represent the following flows, using different colours or line hashing for each.

• invoicing
• assessments/tests/treatments
• activity and other management reporting
• document transmission and receiving
• applications and claims for funding
• payments and collections

Step Six: Visualize your future practice

Review your two pages again and add, modify or delete any of the items you expect to change over the next five years, using a different coloured marker for each of the three revision types (addition, modification, deletion) noting the year in which the change is expected to occur or in which you plan to make it effective. Do not erase any of your original items. Step Seven: Map your internal and external staff

to their locations by role typeFlip the current page over. On a new sheet, draw a box in the middle of the page. Label it “Administrative Hub.” Identify all the roles that work inside the hub, enclosing them in a circle if they are administrative roles, and boxes if they are health service delivery roles (e.g. OTs, physios, etc.) Do the same for the roles that fall outside the box, such as for home offices. Then draw lines between the roles that interact with each other electronically, whether for file transmission, email messaging or document management purposes.

Step Eight: List your performance and service expectations

Now flip the current page over. On another new sheet entitled “Expectations,” print a heading for Features, one for Performance and one halfway down the page for Service. Under Features, list specific requirements that have not been addressed elsewhere. Examples could be “pre-formatted claim form libraries,” “HCAI integration” or “statistical and financial reporting.”

Under Performance, list “Reports” and “Maximum No. Concurrent Users.” Under Service, write the words “Pre-Installation,” “Installation” and “Post Installation” from left to right, evenly spaced. Draw right-tipped arrows between the first and second, and the second and third words. Under Pre-Installation write “data analysis” and “conversion mapping.” Under “Installation,” write the words “data conversion” and “training.” Under “Post installation,” write the words “upgrade policy” and “service desk access.”

Step Nine: Create a blank space to illustrate an end-to-end patient life cycle walkthrough

Flip to a new page. Write the word “Scenarios” at the top. Leave this page blank below the heading.

Congratulations. Only five pages! You cannot call yourself a system analyst yet, but if you’ve come this far, you are certainly entitled to consider yourself expert in the way your practice operates.

You are now ready to invite prospective vendors in for a meaningful discussion of your requirements and learn how they propose to address them with their systems. At some point in the discussion, the vendor should ask you to describe a patient’s life cycle from start to finish. If they don’t, page five is your prompt to bring it up. When it becomes a point of discussion, think of the most complex hypothetical case, as in severe, multiple conditions, multiple payers, multiple representatives and agents. Do not base your hypothetical case on a typical patient; PMS systems succeed or fail on their ability to support variability.

When painting your scenarios for vendors, think in sequential terms, starting with the first time a referral source calls to discuss the particulars of a prospective patient or a prospective client walks into your clinic to inquire about service, and ending with the closing of their file as an active patient. Hence the expressions “life cycle” and “end-to-end.” In the functional, role and locational context you have painted on your first four sheets, you want to know how a vendor’s system supports that life cycle and where it leaves gaps. These gaps, or trade-offs, may be acceptable to you insofar as you are able to handle them with a “work around” that you can live with…or they may not.

Parting Tips

Listen attentively and take detailed notes. In your dialogue with the vendors, the following expressions should gain them points.

• “We built our system using an open architecture”
• “The system is integrated”
• “Please tell me how your practice operates today”
• “Many of our fields are user definable”
• “Where possible, we have incorporated features that require you to input frequently used information only once”
• “We are open to customizing your requirements”
• “Single point of entry”
• “Location-independent access”
• “If you have special reporting needs we will only charge you for our time required to build it using our report writer”
• “Our system is based on an SQL database manager”
• “Our system has multi-level permissions”
• “Our system is fully HCAI, WSIB compliant”

Comments that should prompt you to ask further questions:

• “We upgrade our system according to a fixed schedule”
• “Once you sign on, we will analyze your practice”
• “We use an Access database”
• “We do not customize, but will provide you with the source code”
• “I know the system well because I created it and do all the enhancement myself”
• “We will have to get a programmer to develop your customized reports for you”
• “Your users must be connected in your office in order to use it”
• “To create an OCF-21 or other invoice, you simply pull up the form and input your time and fees”
• “It’s pretty fast up to 10 users”

The number of PMS vendors offering their product in Ontario has mushroomed, particularly since the advent of the HCAI system for auto insurance personal injury claims. Given that fees generated by auto insurance medical/rehabilitation benefits are about $2 billion per year, and the fact that 25,000 providers will have to sign up, it’s easy to see why Ontario has suddenly become an IT product manager’s dream. There is lots of competition, and significant investment is being made to build and enhance systems. We have listed a number of PMS vendors below. Most of them have websites.

• Antibex Software
• Clinicmaster
• Clinic Server
• Copen Computer Consultants
• Healthlink Technologies
• MSF Computing
• Ontario Chiropractic Association (Patient Management Program)
• SmartSimple

About The Author

Charles Spina is a management consultant who specializes in growth strategy and tactics, and brand-aligned operations design and management.