John McCormack


Physicians - being physicians - are generally noted for their due diligence in carrying out their everyday responsibilities, which often involves making life-or-death decisions, frequently with limited information. 

Such diligence is an important asset when physicians leave the exam room to choose the hardware that’s necessary to help their practices operate efficiently. Unlike in emergency clinical situations, however, physicians can take their time gathering as much information as possible when determining which tools will best fulfill their specific business and clinical needs. 

Subsequently, many physicians carefully compare and contrast IT products, using checklists that incorporate considerations such as cost, processing power, memory, mobility, and software vendors’ recommendations. 

This deliberate effort in selecting hardware platforms reflects the fact that medical groups are becoming increasingly computerized, automating not only administrative functions, but also clinical tasks. Carefully contemplating one’s IT choices is crucial because the success - or failure - of hardware platforms within a medical practice frequently hinges on whether or not clinicians will actually use them. 

Many practices have already come to terms with hardware shopping basics and can easily determine which options are best for them based on cost, processing power, and the like. But physicians and their office managers still get caught off guard when they face unexpected scenarios, which can include having to choose among multiple text and data input options; providing patients an easy means to enter data directly into a practice’s electronic system; learning how to interact with patients while simultaneously accessing and entering information with computers; and facing the reality of having to choose alternative hardware tools after the first ones prove untenable. 

Unexpected difficulties turned selecting which computer hardware to support a major IT system into much more than a basic compare-and-contrast shopping expedition at Michigan-based East Lansing Orthopedics. 

Before setting out to digitize their office, physicians at the six-doctor group developed their IT vision for the practice. “Basically, all of our technology decisions are driven by a particular vision of what we want to do,” says Brian McCardel, the physician who took charge of the group’s IT program. 

At the core of this vision is the physicians’ desire to access an integrated practice management system and EMR. “It seemed that the best way to automate both the administrative and clinical functions of our practice was to find a solution from one vendor,” McCardel says. “That way, we wouldn’t always be relying on interfaces.” 

After selecting integrated practice management and EMR software from iMedica in Santa Clara, Calif., the orthopedic doctors had to agree on the type of hardware that would allow them to best utilize their new software. Things quickly got dicey. To make sure his physicians would fully utilize the clinical program they had chosen, McCardel realized the practice would have to meet the clinical data input preferences of each physician. 

“We had to look at hardware that would accommodate multiple ways of doing data entry,” explains McCardel. “Each of the physicians had their own ideas about how they wanted to get information into the electronic records. Some of the doctors wanted a keyboard to type in data. Others wanted to write information directly into the record. Some just wanted to be able to dictate the information into the system, and others wanted to hand-write text into the system using a stylus.” 

Accommodating all these wishes seemed a bit pie-in-the-sky, but McCardel knew that the practice’s technology initiative depended on physician buy-in to succeed. “The more options we could provide, the more likely it would be that the physicians would actually adopt the technology,” he reasoned. 

To accommodate everyone, the practice chose tablet PCs from Motion Computing in Austin, Texas. The 3-pound, slate-shaped tablet PCs - about the size of a clipboard - feature a bright 12.1-inch screen that allows doctors to view a full-page document without scrolling. The PC’s design makes it easy for doctors to carry it under one arm, enabling them to move about just as they did with paper charts. As the practice continues to roll out its tablet PCs, its physicians are coming to appreciate the benefits of a computerized practice, says McCardel. 

“There are many benefits that we will realize from the system,” he says. “But already, there really is nothing like being able to carry your computer with you wherever you go and access information about any of the patients who see a doctor in our practice. It’s a great convenience, especially when you are on call and answering questions about a variety of patients, some of whom are not yours.” 


Meeting the diverse IT needs of an opinionated group of doctors is difficult enough, but some practices must also accommodate individual patient technology preferences. 

The National Spine Network is a nonprofit organization based in Marietta, Ga., that unites 28 independent centers of excellence for spine care. It includes a number of small orthopedic and neurosurgery practices, which, with each of the other organizations that make up the network, face a set of unique challenges when it comes to selecting computer hardware. Their success depends upon implementing an IT program that makes their 

Why? Because each medical group in the network uses SpineChart, a clinical program that requires patients to enter information directly into the system. “This clinical software is different from clinical software that is used in many other practices,” says Harry Freedman, the network’s executive director. “Not only does it require that clinical staff input data, but it also requires that patients do so as well. And that is something that many other clinical programs don’t do.” 

As a result, Freedman finds himself making hardware recommendations that must meet the needs of three parties: clinicians, administrators, and patients. 

Patients within the network use touch-screen technology to input their personal data. Practices can provide either stationary desktop computers in their waiting rooms or give mobile devices to their patients to collect their data. Because most network practices lack the space in their waiting rooms to offer all patients access to desktop PCs, they typically go with the mobile option, Freedman says. 

Freedman recommends that the network’s practices provide patients with tablet PCs. He says he prefers tablets to laptops because a laptop’s keyboard can easily distract patients. For the network’s clinical and administrative staff, he suggests a combination of desktop, laptop, and tablet options, depending upon the users’ mobility needs at each practice. 

The most important consideration for such practices? Make sure you buy your equipment from a trusted vendor. 

“Dependability is important because physicians and staff members have to rely on the equipment for so many vital functions,” says Freedman. 

Patient needs were a prime consideration for Elaine Gutierrez when she decided to implement an EMR at her private practice in Torrance, Calif. 

Although usability and cost were important issues when Gutierrez sought to purchase the hardware that would make the most of her EMR, she had a few other concerns as well. Most important to her was to ensure her computer use would not interfere with patient interactions. 

“I wanted to be able to make eye contact with my patients while I was taking their histories,” says Gutierrez. “If you have a desktop computer in the corner of the exam room, it is really hard to do that. And it is really hard to make eye contact when you bring a laptop in and just place it on the countertop.” 

Gutierrez also worried that her pediatric patients might view new desktops in the office as toys while they waited to see her. “I thought the kids might bang on them and ruin them,” she says. 

Gutierrez settled on a Dell laptop. She can wheel her compact computer into exam rooms on a rolling cart, enabling her to adopt a position in which she can easily interact with her patients. And Gutierrez is gaining another unexpected benefit from the set-up she chose. Her back and neck don’t bother her nearly as much as they once did. 

“When I had been working with paper records, I would lean over and write on the counter. I started having problems with my neck and shoulder from the writing,” she explains. “Now I can adjust the laptop to the perfect height - and I don’t feel any strain.” 

Like many other physicians who have evaluated different hardware platforms, Gutierrez realizes that choosing the right tool was crucial to her successful foray into the world of EMRs. But many other practices aren’t so lucky with their first choice. 

For example, ’Specially for Children, a pediatric subspecialty group based in Austin, Texas, initially used wireless PDAs to access the new EMR it purchased in the late 1990s, but the physicians in the group quickly realized that the small gadgets didn’t have what it took to make the most of their investment; the PDAs were unable to hold large files, and they had limited function and input capabilities. 

Rather than dropping the EMR altogether, however, the practice’s physicians decided to try tablet PCs. Deployed over a wireless network, the group now taps easily and happily into its EMR software applications using its new interface tools. 

“The tablet makes it possible for me to do more in real time,” says Jeff Zwiener, a pediatric gastroenterologist within the group. “Our charts are more accurate and almost impossible to lose, since they’re electronic.” 

The practice expects its EMR to yield additional bottom-line benefits. With its new system in place, it is eliminating $130,000 to $180,000 in paper chart costs per year. And because doctors and staff members now work more efficiently, the practice will be able to see an additional 2,500 patients annually without having to add staff members. 

has been a healthcare journalist for 15 years. He has served as associate editor for 

Articles

Evaluate your peripheral options carefully when purchasing an EMR. If your physicians are uncomfortable with the PDA or tablet PC you choose, they’ll go back to paper.

EMR Interface: Making Hardware Fit Your Needs

Such diligence is an important asset when physicians leave the exam room to evaluate the hardware that’s necessary to help their practices operate efficiently. Unlike in emergency clinical situations, however, physicians can take their time gathering as much information as possible when evaluating which tools will best fulfill their specific business and clinical needs. 

This deliberate effort in selecting a hardware platform reflects the fact that medical groups are becoming increasingly computerized, automating not only administrative functions but also clinical tasks. Careful contemplation of IT choices is crucial because the success - or failure - of hardware tools within medical practices frequently hinges on whether or not clinicians will actually use them. 

Many practices have already come to terms with hardware shopping basics and can easily determine which options are best for them based on cost, processing power, and the like. But physicians and their office managers still get caught off guard when they face unexpected challenges, including giving physicians multiple text and data input options; providing patients an easy means to enter data directly into a practice’s system; enabling physicians and other clinicians to interact easily with patients while accessing and entering information into computers; and persuading physicians to try alternative hardware forms after a computerization launch fails. 

For example, settling on specific computer hardware to support a major IT system at East Lansing Orthopedics in Michigan turned into much more than basic compare-and-contrast shopping when unexpected difficulties arose. 

Before setting out on their initiative, physicians at the six-doctor group developed their IT vision for the practice. “Basically, all of our technology decisions are driven by a particular vision of what we want to do,” says Brian McCardel, the physician who took charge of the group’s information technology program. 

At the core of their vision is the physicians’ desire to access an integrated practice management system and EMR. “It seemed that the best way to automate both the administrative and clinical functions of our practice was to find a solution from one vendor,” McCardel says. “That way, we wouldn’t always be relying on interfaces.” 

After selecting integrated practice management and EMR software from iMedica in Santa Clara, Calif., the orthopedic doctors had to agree on the type of hardware that would allow them to best utilize their system. Then things got dicey. To make sure these physicians would fully utilize the clinical program they had chosen, McCardel realized the practice would have to meet the clinical data input preferences of each physician. 

“We had to look at hardware that would accommodate multiple ways of doing data entry,” he explains. “Each of the physicians had their own ideas about how they wanted to get information into the electronic records. Some of the doctors wanted a keyboard to type in data. Others wanted to write information directly into the record. Some just wanted to be able to dictate the information into the system, and others wanted to hand-write text into the system using a stylus.” 

Accommodating all these wishes seemed a bit pie-in-the-sky, but McCardel knew that the practice’s technology initiative depended on physician buy-in to succeed. “The more options we could provide, the more likely it would be that the physicians would actually adopt the technology,” he says. 

To accommodate these diverse data-entry preferences, the practice chose tablet PCs from Motion Computing in Austin, Texas. The 3-pound, slate-shaped tablet PC - about the size of a clipboard - features a bright 12.1-inch screen that allows doctors to view a full-page document without scrolling. The PC’s design makes it easy for doctors to carry it under one arm, enabling them to move about just as they did with paper charts. As the practice continues to roll out its tablet PCs, its physicians are coming to appreciate the benefits of a computerized practice, says McCardel. 

“There are many benefits that we will realize from the system,” he affirms. “But already, there really is nothing like being able to carry your computer with you wherever you go and access information about any of the patients who see a doctor in our practice. It’s a great convenience, especially when you are on call and answering questions about a variety of patients, some of whom are not yours.” 


Meeting the diverse IT needs of an opinionated group of doctors is difficult enough, but some practices have to accommodate the tech preferences of their patients as well. 

The National Spine Network is a nonprofit organization based in Marietta, Ga., that unites 28 independent centers of excellence for spine care. It includes a number of small orthopedic and neurosurgery practices, which, with each of the other organizations that make up the network, face a set of unique challenges when it comes to computer hardware choices. Their success depends upon implementing IT that makes their patients happy as well. 

Why? Each medical group in the network uses SpineChart, a clinical program that requires patients to enter information directly into the system. “This clinical software is different than clinical software that is used in many other practices,” says Harry Freedman, the network’s executive director. “Not only does it require that clinical staff input data, but it also requires that patients do so as well. And that is something that many other clinical programs don’t do.” 

As a result, Freedman finds himself making hardware recommendations that must meet the needs of clinicians and administrators as well as their patients. 

Patients within the network use touch-screen technology to input their personal data. Practices can provide either stationary desktop computers in their waiting rooms or give mobile devices to their patients to collect their data. Because most network practices lack the space in their waiting rooms to offer patients access to desktop PCs, they typically go with the mobile option, Freedman says. 

Freedman recommends the network’s practices provide patients with tablet PCs. He says he prefers tablets to laptops because a laptop’s keyboard can easily distract patients. For the network’s clinical and administrative staff, Freedman suggests a combination of desktop, laptop, and tablet options, depending upon the users’ mobility needs at each practice. 

But Freedman says the most important consideration for practices is to ensure that they buy their equipment from a trusted vendor. 

“Dependability is important because physicians and staff members have to rely on the equipment for so many vital functions,” says Freedman. “That’s why I feel more comfortable recommending that doctors buy from a known company.” 

Patient needs were a prime consideration when Elaine Gutierrez decided it was time to implement an EMR at her private practice in Torrance, Calif. 

Although typical usability and cost questions were also issues when Gutierrez sought to purchase hardware to make the most of her EMR, she had a few other concerns as well. Most important to her was to ensure her computer use would not interfere with patient interactions. 

So Gutierrez settled on a Dell laptop. She can wheel her compact computer into exam rooms on a rolling cart, enabling her to adopt a position in which she can easily interact with her patients. And Gutierrez is gaining another unexpected benefit from the set-up she chose. Her back and neck don’t bother her nearly as much as they once did. 

“When I had been working with paper records, I would lean over and write on the counter. I started having problems with my neck and shoulder from the writing,” she explains. “Now, however, I can adjust the laptop to the perfect height - and I don’t feel any strain.” 

For example, ’Specially for Children, a pediatric subspecialty group based in Austin, Texas, initially used PDAs to access its new EMR, but the physicians in the group quickly realized that the small gadgets didn’t have what it took to make the best use of their investment. 

In the late 1990s, the pediatric group’s physicians, convinced of the patient care and business benefits of EMRs, purchased a system for their practice. They used wireless PDAs to access their EMR, but they soon realized those PDAs were unable to hold large files and had limited function and input capabilities. 

Rather than dropping the EMR altogether, however, the practice’s physicians tried another hardware platform: tablet PCs. With tablet PCs deployed over a wireless network, the group now taps easily into its EMR software applications. Most important, the physicians are happy with their switch to tablets. 

“The tablet makes it possible for me to do more, in real time,” says Jeff Zwiener, a pediatric gastroenterologist with the group. “Our charts are more accurate and almost impossible to lose since they’re electronic.” 

The practice expects the new EMR to yield additional bottom-line benefits. With its new system in place, the group is eliminating $130,000 to $180,000 in paper chart costs per year. And because doctors and staff members now work more efficiently, the practice will be able to see an additional 2,500 patients per year without having to add staff members. 

has been a healthcare journalist for 15 years. He has served as associate editor for

This article originally appeared in the September 2006 issue of

PC or laptop? Handheld or tablet? Better choose your hardware platform carefully. It's a decision you'll have to live with for a while.

Technology: Hardware’s Hard Challenges


Bruce Sabin went from practicing internal medicine in a large HMO-owned office in Atlanta to opening his own practice in Snellville, Ga., for one reason: He wanted to treat patients the same way he would want his own family members treated. 

In his mind, that meant overseeing the entire “circle of care.” 

“I diagnose and treat medical problems. So I want to provide patients with their prescriptions and make sure they are taking their medications,” Sabin says. “When I was working at a large group, I noticed that patients were not compliant and didn’t properly take their prescriptions. They wouldn’t get their prescriptions filled at the pharmacy or they waited too long to get them filled or would never get refills.” 

Sabin’s patients are hardly an aberration. Indeed, about 21 percent of patients never get their prescriptions filled, according to the American Association of Retired Persons. Also, about 30 percent of patients who should get their prescriptions refilled fail to do so, according to the journal 

So for business and quality-of-care reasons, some physicians - perhaps 7 percent, according to some estimates - have started to dispense prescriptions to their patients at the point of care. To do so, many practices have implemented prescription-dispensing systems within their offices that make it easy to provide prepackaged medication while patients are in the office in lieu of writing prescriptions for them to fill at pharmacies. 

These prescription-dispensing systems can also bring in additional revenue. But some industry observers say the extra time and effort required to sell prescriptions within practices is not worth the headache, despite the additional income. 

There is also an ethical concern. Although it is legal for physicians to sell medications to their patients at the point of care in most states, some question whether physicians should profit from this practice. Critics worry that the money-making motive might cloud doctors’ clinical judgment. 

For example, physicians might prescribe only the medications that they stock rather than a more clinically effective alternative. Indeed, the American Medical Association discourages selling prescriptions within physician offices except at cost. 

But supporters of the practice say the benefit of in-office drug dispensing to patients and physicians outweigh the drawbacks. They claim the following advantages: 

 Errors occur in about 5 percent of all medications dispensed from a pharmacy, according to the National Association of Boards of Pharmacy. 

Azar Korbey, a primary-care doctor who uses an Allscripts prescription-dispensing system in his two-physician practice in Salem, N.H., claims the system increases his control and decreases his chances of making a prescribing error. 

“We have had quite a few problems with patients not getting the exact prescription or dosage that we prescribed,” Korbey says. “When I am actually dispensing the medications, I know that the patients are actually getting what I want them to take.” 

 As Sabin claims, many physicians who dispense medications at the point of care say because their patients can get their prescriptions filledon-the-spot, compliance increases. 

Sabin, who uses a system from Physicians Total Care, says his patients have become more compliant with their treatments simply because he personally goes over their prescription protocols as he dispenses medications to them. 

“Patients take their medications a lot more seriously when they receive the prescriptions and instructions directly from me, the doctor who is treating them,” Sabin says. “I’ve seen a big difference in how closely they follow the instructions and actually complete their treatment regimens.” 

Being able to track patient compliance with refills is another plus, say advocates. “I have the ability to track the refills,” says Korbey. “I know that a patient with high blood pressure, for example, should be getting refills every month. If the patient is not having the prescription refilled, I can follow up and see what is going on.” 

What’s more, the dispensing systems - many of which offer access to patients’ prescription histories - can help clinicians detect when patients are trying to get unneeded drugs, says Patrice Pash, practice manager at Physicians Immediate Care in Rockford, Ill., which uses an automated dispensing system from DRx Pharmaceutical Consulting. 

“The biggest advantage with the Web-based system is that we will be able to integrate all six of our care-center sites together,” Pash says. “By doing so, we will be able to see if patients have been at each of the locations and what their prescription history is.” 

She adds, “We get hammered by narcotics seekers. With this system in place, we are able to see if someone has gotten medications at other locations. So it quickly becomes apparent if they are going from location to location trying to get drugs to support their addiction.” 

 Susan Miller, RN, administrator at Family Practice Association of Lexington, says her nine-doctor practice in Kentucky started using a dispensing system from Allscripts about five years ago primarily as a way to improve patient services. 

“For example, say it is 28 degrees outside and the snow and wind is blowing [and] a parent brings a child in with an ear infection,” says Miller. “Well, we can provide the medications right on the spot, instead of having the parent and child go to the pharmacy.” 

Providing patients with a convenient means to get medications was one of the reasons the four oral surgeons at Oral Surgery Plus in Spokane, Wash., implemented a prescription dispensing system, says Debbie Bradley-Kizziar, a physician at the practice. 

“Since virtually all of our patients come in for some type of surgery, just about every patient requires some type of medication,” she explains. “Most of our patients need to have someone drive them home. Getting the prescriptions right here just makes the process much easier. Whoever is driving doesn’t have to leave them in the car and trek into the pharmacy to get the medications. The patient can get home a lot quicker, get comfortable, and start recovering,” she says. 

 In many cases, onsite dispensingsystems enable physicians to offer prescriptions to their patients at a price that is less than what the patients might pay at a commercial pharmacy. 

“The patients really appreciate having the ability to get their medications in the office, especially on the many occasions when we can savethem considerable amounts of money,” Korbey says. “I had a patient not too long ago who was literally able to get his prescriptions at half the price of what he could have gotten them for in the pharmacy.” 

So is there anything wrong with making some extra money while providing patients a service they want and can benefit from? “Doctors have been dispensing medications since the days of house calls. So I don’t really see any reasons why they should not do it,” says Andrea Serratte, CPA, president of Specialty Services of America, a Phoenix-based healthcare consulting company. 

Vendors who sell prescription-dispensing systems say practices can clear anywhere from $20,000 to $100,000 a year if they adopt in-house drug dispensing. 

Bradley-Kizziar notes that each of the four doctors in her practice bring in about $1,000 per month in additional revenue through in-office prescribing. Korbey estimates that his two-doctor practice earns about $2,500 per month in additional revenue. For Sabin’s practice, the extra money adds up to $6,000 a month. 

Randy Vogenberg, senior vice president in the Life Science Practice at AON Consulting in Chicago, agrees that on-site dispensing could help practices bring in additional income, but she stresses that physicians need to carefully analyze the pros and cons of selling prescriptions in their practices. 

First, she says, physicians should assess whether the money they will make from dispensing is worth the time it takes to actually administer the dispensing system. 

Second, practices need to evaluate their liability risks. Physicians need to know the regulations in their states regarding who may dispense drugs. A few states, such as Texas, forbid the practice altogether. In others, only a physician may dispense pharmaceuticals. Other states allow nurses and nurse practitioners to dispense. But whoever does the dispensing, physicians will still carry all of the liability. 

“The physician is liable for all of the drugs that are dispensed. So they would have to make sure that there is nothing out of date or any other problems,” says Vogenberg. “How do you measure the liability? If something goes wrong it could become a nightmare. Physicians need to think about whether or not it is worth the aggravation.” 

But Priscilla Ray, a Houston psychiatrist and chairperson of the American Medical Association’s Council on Ethical and Judicial Affairs, says that physicians simply should not seek to profit from the sale of prescriptions to their patients. 

“The concern, of course, is that there would be a risk of exploiting patients - even inadvertently,” she says. 

Ray suggests that physicians offer their prescriptions free or at cost to avoid any questions about motives. Physicians who do choose to earn revenue from filling prescriptions should disclose that fact to their patients, she says. 

Many physicians who are already dispensing medications in their offices claim they would never let the profit motive interfere with their clinical recommendations. They perceive in-office dispensing as a win-win solution for all involved. 

“Honestly, I can’t see any negatives or drawbacks to dispensing in the office,” says Korbey, who has been dispensing medication himself for about 20 years. “I am giving patients the best medicine at the best price. I am saving them money out of their pocket and helping them recover better and faster. And, honestly I just think that is good medicine.”

John McCormack has been working as a healthcare journalist for 15 years. He has served as associate editor for 

This article originally appeared in the June 2006 issue of Physicians Practice

A small but growing number of physicians are selling and dispensing medications right from their offices - boosting revenue while adding a convenience for patients. And new technologies are making it easier. Can it work for you?

Growth Strategies: Psst … Buddy - Want to Sell Some Drugs?

Are you one of those physicians who looks at your practice’s general ledger and then at the price of technology systems - and trembles? We understand. Those price tags can be daunting. But investing in information technology is not as scary as it first appears. 

As a matter of fact, the initial reaction is often a case of unwarranted sticker shock. What you need to do is get beyond the price tag - and evaluate what a computer system will really do for your office, says Rosemarie Nelson, a Medical Group Management Association consultant based in Syracuse, N.Y. 

If you do, you’ll find that buying technology - if you do it right - is an investment worth making, not simply another "cost."

"Instead of just looking at the price of information technology, physician practices should start by looking at their objectives," Nelson says. "Physicians should not concentrate on the costs but should instead look at how the technologies can help them meet clinical and operational objectives that will lead them to serve their patients more effectively, run their practices more efficiently - and, in the end, save money." 

How can you get beyond the initial fright associated with plunking down a large sum of money for technology? First, ask the right questions and determine exactly what the technology can do for your practice. Then, evaluate all available options to find the right hardware and software for your practice, making sure to choose a system that your physicians and other clinicians will use. And finally, after you have gone through this process, then - and only then - zero in on price and start working to get the most for your dollar. 

"You really need to have a firm understanding of what it is that you want to achieve," Nelson says. "Rather than saying, ‘We found this computer program and are going to spend X amount of dollars,’ you need to start by determining exactly what you want to get out of a computer system." 

For example, you might identify the need to improve care delivery processes - or simply to improve the quality of life for your clinicians by making it easier to practice medicine. Or you might be looking to cut costs by reducing the administrative burdens associated with running a practice. 

Joel Sauer, CEO of The Heart Center Medical Group, a 44-physician cardiology practice in Fort Wayne, Ind., says that cost is never the top concern when looking to bring technology into the group. 

"Sometimes, there are clinical care reasons prompting us to bring in information technology and those far outweigh any other considerations, including costs," he says. "We will also look at our operations and determine what the ramifications are of putting in a piece of technology, specifically looking to determine if there are return-on-investment opportunities."

Your first questions should include: What would help my doctors and midlevels provide better service to patients? What can be done to give physicians and nurses better information at the point of care? 

Then you should look at your own operational costs and consider whether you’re spending too much to do things like manually produce billing statements and pull charts by hand. And remember: time is money.

Nelson suggests you grab a clipboard, pencil, and stopwatch - and start timing how long it takes to manually perform many of the tasks that could be streamlined with automation. Take the time and multiply it by the hourly rate of the worker performing the task and you’ll quickly see just how expensive it really is to run your practice. 

"For example, on average it costs between $5 and $12 just to pull a patient chart. That’s because most of the charts are not filed away in the cabinet. Instead, they are buried under mounds of paper somewhere in the practice," Nelson points out. "But most practices don’t discover these costs and potential savings because no one takes the time to do a time-motion study and figure out exactly how much it costs to get routine, everyday tasks completed."

Taking such an approach could help you discover that you actually need - and can afford - more technology than you originally thought, Nelson says. (Nelson also reveals the most common mistakes practices make with technology on page 33).

Price was far down on the list of considerations when Jim Stape, practice manager at Gilbert Center for Family Medicine in Gilbert, Ariz. began searching for an electronic medical records system a few years ago. Stape was primarily concerned with bringing in a system that would help the practice avoid potential legal liabilities - while also reducing operational costs. 

"The threat of dealing with liability and lawyers has become so huge that at least one physician owner was considering retirement. We wanted to decrease her concerns by adding technology that could help to avoid the liability," Stape says.

As a result, the practice needed to find a system with features and functions that would help to provide and document unquestionable service. And that meant relegating price to the back burner. 

"I don’t think the way we went about doing this is typical. Honestly, we didn’t ask for a price quote until we narrowed our search down to the final three vendors," Stape says. 

Sure enough, with an EMR from NextGen Healthcare Information Systems in place, the practice’s clinicians can more thoroughly monitor the standard of care. For example, clinicians can easily access all lab results and, therefore, might be more likely to quickly diagnose specific health problems. In addition, the EMR helps doctors provide proactive care by automatically sending letters to patients reminding them to come in for preventive services such as mammograms. By utilizing these functions, the practice is reducing the threat of liability, Stape says. 

In addition to the potential legal cost avoidance, the practice is also realizing hard-dollar returns on its investment. For example, the practice is now saving about $15,000 a year annually due to the elimination of the paper chart supplies. Improved administrative processes, such as the decreased need to manually pull charts, have resulted in the elimination of three FTEs, saving the practice about $90,000 annually. And the decreased need for transcription services saves the group $60,000 per year.

Just as important as getting the functionality you need, however, is getting a system that your clinicians will use, The Heart Center’s Sauer says. 

To get full cooperation from clinicians, Sauer advocates taking gradual "baby steps." That’s why he decided to implement a document management system before migrating to a full-blown EMR.

"To move all of the clinicians from a paper-based system to an EMR would have been much too difficult," Sauer says. 

The approach also has helped the practice avoid bringing in information technology that is not yet ready for prime time. 

"The EMR has been around for a long time. But if you look at the list of vendors that were around in 1996 and compare it to the vendors that are around today, you will see that many of them didn’t make it," Sauer says. "Even though we didn’t really do it by design, waiting to implement an EMR has saved us from a train wreck. We haven’t had to go through the painful evolution associated with emerging technologies."

Don’t get us wrong: price does matter. It shouldn’t be the first or most important thing you consider - you should never purchase something just because it’s less expensive than a competing product, nor shy away from something you need just because you perceive it as too expensive - but at some point price will and should be considered. And you should make an effort to get the lowest price possible for the technology you want.

Stape, for example, says that once he identified his three final vendors, he "put his boxing gloves on." 


Here are a few of the tactics that he put into play to help get the best deal for his practice:

 "Every single vendor wants to know what your budget is. But it’s important to never tell them what you are willing to spend. By keeping them guessing about how much you can spend, you are more likely to get the best price," Stape says. 

 Using a request for proposal (RFP) makes it possible to get beyond the marketing flak and compare systems on a feature-by-feature basis, Stape says. You can find an RFP form for free at www.PhysiciansPractice.com. Click on our Buyer’s Guide tab, pick a product category, and then click the RFP function. Just fill out the form and start getting responses within hours. 

 Stape let all the contenders know who their competition was - and purposely left one low-priced vendor on the list to encourage the others to bring their final price quotes down. "It made the others sharpen their pencils," Stape says.

Some medical groups haven’t gotten beyond the initial fear of "wasting" money on information technology. The Working Group for HIT in Small Medical Practices, however, is. 

"The opportunity to make mistakes in purchasing information technology is still too high for many medical groups," says Peter Basch, MD, leader of the working group within the nonprofit eHealth Initiative that’s looking to help practices with 10 physicians or less meet the information technology buying challenge. "We are looking to lower the barriers and help medical groups move forward with purchases."

This fall, the group is scheduled to release its EHR (Electronic Health Record) Master Quotation Guide, a "how-to" for small practices that are soliciting quotations and negotiating contracts with vendors. The guide will provide:

 "This will help medical groups move forward more confidently, knowing that the vendors they are considering are a reasonable choice and offer a viable product," Basch says. (You can also find a listing of EHR vendors, as well as pricing and other information, on page 43, in the debut of our feature, "The Guide". Look for other kinds of technologies in future issues.) 

 To help practices get the most out of EHR implementations, the group is calling on specialty organizations to come up with lists of vendors offering products that closely match the requirements of certain specialties. "Some technology products are perfectly suited for cardiologists and some for family practitioners. This will simply help practices know which ones are best for their unique needs," Basch notes. 

 With these request-for-bid documents, practices will be able to know exactly what each technology vendor is offering. "It really just standardizes the way products are presented," Basch says. "As a buyer, you will be able to know exactly what you are looking at. You will be able to compare features, service level agreements, and add-ons. It will make it as easy as looking at stickers on new cars and comparing common attributes from car to car."

John McCormack has been working as a healthcare journalist for 15 years. He has served as associate editor for Materials Management in Health Care and as managing editor for Health Data Management. He can be reached via 

This article originally appeared in the September 2005 issue of 

How to get over the price tag and approach IT buys like the smart investments they (usually) are.

Sticker Shocked?

Quick: how many boxes of cotton balls does your practice go through every month? Ballpoint pens? How well are you managing your flow of sample drugs - and the flow of pharmaceutical reps through your office?

Controlling inventory and managing the purchasing process efficiently is a problem for many small practices, but new tools are emerging to make it all simpler. Chief among these is barcoding technology, which is being aggressively adopted by hospitals and large healthcare systems, and may soon become the next big thing in private practices.

Meanwhile, some old Web-based tools, including online purchasing, continue to gain favor among practices. 

And here's the kicker: some of these tools are free. 

Take, for instance, PreferredTime, a Boston-based service that coordinates sales rep visits online. "It has worked great for us," says Denise Tanner, administrator of Anthony Medical Clinic, a small group in Gastonia, N.C. "The front-office personnel love it because it saves them so much time each day. We are a busy, thriving practice, and we would have sales reps in here all the time. Sometimes, we would have six or seven of them waiting to see the doctor. It just took a lot of time to manage it all."

Anthony Medical provides PreferredTime a list of times when it would like to see reps, and the reps sign up for those times through the service. As a result, there's never a backlog of reps in the office waiting to see the physicians - and the doctors have a better idea of who they will see and when. Typically, the pharmaceutical reps pay to use the service.

Tools such as PreferredTime are among those that streamline the process of stocking the shelves for practices large and small, while reducing costs of ordering supplies and managing inventory. 

Is barcoding technology right for a small or medium-sized office like yours? Varnessa Pontius of Milwaukee-based KDA Consultants, a healthcare materials management consulting firm, thinks it might be. 

She says barcoding is being adopted quickly by hospitals and large group practices to control inventory and cut costs, and while smaller practices have not yet jumped aboard in significant numbers, many such groups will likely consider barcoding technologies once they realize the advantages. 

"I think the smaller practices could be overlooking potential cost savings," she says. For example, practices might be losing money due to excess inventory sitting on the shelves or due to lost or stolen supplies. 

Still, your volume of supply purchasing may be too small to make barcode technologies worthwhile, Pontius says. 

What's more, some practices might be ordering additional supplies simply because staff members don't know where to look for what they need.

Here's how a barcoding system might help: all supplies and patient charts are coded. Then, staff members scan items as they take them off the shelves, making it possible to link the number of supplies used to individual patients, procedures, or physicians.  

"These systems let you know where your resources are going," Pontius says. "With a barcoding system in place, for instance, you are able to tell if certain physicians are underusing or overusing supplies. You are just able to have a better handle on what is going on."


Steve Fiore of Hayes Management Consulting in New Center, Mass. agrees that private practices could benefit from barcode technologies, but advises them - especially smaller ones - to carefully weigh the costs against the benefits.

"I don't see this being used with Band-Aids and syringes and other relatively low-cost items," Fiore says. "Barcoding, however, is very valuable with the higher-end inventory. For instance, I could envision systems being used in oncology practices, where there is a lot of high-end inventory and expensive medications."

By far the most common tool for inventory management among private practices is online supply ordering, something more practices are doing than ever before. Even so, plenty of practices continue to make purchases with pencil and paper.  

If you're in that late-adopter group, it may be helpful to consider some advantages of switching to a Web-based system.

For one thing, it's cheaper. The average administrative cost per purchase order, from requisition and approval through generation of the purchase order, ranges from $75 to $150, according to research cited in 

, a white paper published by Denver-based Omnicell, which offers Internet procurement products to the healthcare industry. 

E-procurement systems can reduce these costs to as low as $6 per purchase order by:

automating the purchase requisition, approval, and order process;

reducing errors and the time it takes to rework orders;

providing online access to multiple suppliers, thereby facilitating price comparisons;

saving administrative time by streamlining the purchasing process; and

providing aggregated data, enabling the practice to negotiate better prices with suppliers.

Women's Health Inc. in Cincinnati is one medical group that has bought into the e-commerce promise. 

"We were looking to improve efficiency in the office all-around - and to come up with a better way to do our supply ordering," says administrator Pat Webb, recalling the seven-physician OB/GYN group's decision to switch to an Internet-based ordering system five years ago. "So I naturally started looking at Internet options and solutions."

When a company called Esurg came calling, Webb realized that she had found her solution. Esurg offers online access to medical and surgical supplies, pharmaceuticals, equipment, and office supplies. 

Like other online services, ESurg signs up manufacturers, distributors, and suppliers to list products on their site. Physicians and practice administrators go to the online source to compare prices and place orders, eliminating the task of calling suppliers one at a time. 

Since signing on with Esurg, Women's Health has realized many of the Internet's promises. Instead of having a medical assistant walk around the practice with a clipboard noting what supplies are needed and then calling distributors to get the best prices, the entire process is automated. 

Supplies are ordered based on usage patterns that are computed by Esurg. And instead of searching for the best prices, Webb can see everything that is available online - and easily determine the best deal. The ordering process is streamlined and the practice has better access to supplies, Webb says.

Webb has a better overall picture of supply usage at the practice. She routinely prints reports and compares what is being used to the procedures performed at various locations. This way, she is able to pinpoint where clinicians are either overusing supplies or are not using less-expensive alternatives.

"We can easily do a comparison of ... the volume of patients coming through and what we routinely order to figure out what we will need," Webb says. "We can also see our inventory at a glance, whereas we had no idea what we had before."

It's common for practices to be in the dark about their own inventory status. Yet that makes it next to impossible to know how much of anything to purchase.


"We would order too much or forget to order some things that we really needed. Before, we would go into supply areas and find boxes of supplies that we really didn't need and we would have to return them," Webb says.  

Cutting out the inefficiencies and getting the best pricing netted $30,000 worth of savings during the first year the practice used the service. Since then, the group has reduced its medical supply bill by about 10 percent to 15 percent annually.

While Women's Health and other medical groups have been reaping the benefits of online purchasing for some time now, if you're on the sidelines, you might want to take a second look at the online purchasing services offered by e-commerce companies, group purchasing organizations, and suppliers - and consider jumping into the fray.

This article originally appeared in the July/August 2005 issue of 

To be sure they always have enough cotton balls, sutures, and drug samples, practices are using tools like barcoding and Web-based purchasing to get a handle on inventory - and control costs. Are these tools right for you?

Controlling Inventory

For years, the promise of a paperless office loomed as a nirvana of sorts. Now, as more medical groups are actually moving toward paperless realities, they're discovering that there is, indeed, some trouble - or at least unexpected hassles - in paradise.

Sure, doctors and administrators are glad to be rid of the paper mess, the rows of file cabinets, and the storage room expense. But there is also a growing need to manage electronic systems, specifically to utilize reliable electronic data storage solutions. And this catches some practices unprepared. 

"A lot of physician practices begin to computerize and they see all of the advantages," says Deborah Kohn, principal of Dak Systems Consulting, based in San Mateo, Calif. "Unfortunately, I don't think they understand the full equation. They don't understand that with computerization you inherit the responsibility to manage your computer system - and that means you have to become responsible for functions such as data storage, back-up, and recovery."

As more groups adopt practice management, electronic medical records, and imaging systems, addressing electronic data storage issues is becoming increasingly important. Don't know how to get started? Here are seven tips from those who've already wrestled with electronic data storage issues.

Doctors and administrators are learning that computer systems need some tender loving care. And that means finding the right caregiver. Fortunately, it's not necessary to have a computer whiz with advanced knowledge. With the date for compliance with the federal security rule already passed, you likely have identified someone in your practice who has an affinity for computers and has responsibility for the maintenance of your computer systems, including the protection of the data stored in those systems. 

The administrator should ensure that there is enough data storage capability on the practice's computer hardware to handle the requirements of software programs, and analyze products for data storage capabilities. He or she would also take the lead in assuring that data is backed up and that proper safeguards exist to prevent the data from falling into the wrong hands. By designating a systems administrator (or security official), your practice will ensure that computer maintenance and data storage issues will not fall through the cracks. 

Because storage space is limited in every computer system, the administrator needs to constantly keep tabs on what's needed. Different programs will have different data storage requirements. For instance, e-prescribing software will have little or no impact on storage needs, while picture archiving communications systems will eat up space, Kohn says.  "You should be monitoring your systems on a daily or weekly basis as to interfaces and disk space and running utility programs that would prompt action," says Rosemarie Nelson, a consultant with the Medical Group Management Association of America. Your own computer can tell you this, through a utility program that performs specific tasks related to the management of computer systems - such as the monitoring of storage space. 

Similarly, when purchasing new computer programs, the administrator should always ask the software vendor about storage requirements.

When your system has reached about 85 percent of capacity, it's time to do something about it, Nelson says. To rectify the situation, you can begin to archive more documents or simply add more storage space. The good news is that data storage is relatively inexpensive. Typically, data storage costs amount to less than 10 percent of complete network configuration. 

As more groups adopt practice management, electronic medical records, and imaging systems, addressing electronic data storage issues is becoming increasingly important. Don't know how to get started? Here are seven tips.