Replacing Your Practice Management System

Between attempting to meet meaningful use of your EHR and preparing for the ICD-10 medical coding transition, chances are you've pondered an upgrade to your practice management system. External forces like these are driving many practices to better align all of their internal technology products, according to experts.

"Much of the change right now is being driven by the rush to EHRs because of the incentives and penalties in the Affordable Care Act," says internal medicine physician Jeffrey Hertzberg, president of Medformatics, Inc., a consulting firm specializing in design, selection, and implementation of healthcare information systems.

The main issue, according to Hertzberg and others, is how closely you link your practice management system to your EHR, i.e., do you build one to accommodate the latter, or go with two programs.

And don't forget the ICD-10 transition, recently delayed by Congress to Oct. 1, 2015 at the earliest, another mandate for which your practice - and your practice management system - must be prepared or face a hit to your bottom line.

"You can tolerate a [practice management] system that might have weak functionality or one that isn't the most modern or sexiest in the world, but with ICD-10, it's either compliant or not compliant," says Jeffery Daigrepont, senior vice president for The Coker Group, a national consulting firm. "With ICD-10, there's no forgiveness whatsoever."

Selection support

If you're considering a practice management system switch, our experts have some advice to ensure smooth sailing from the early stages of shopping around to signing on the dotted line with your new vendor partner.

• Find the right fit. There are lots of options on the market and lots of vendors. How do you narrow down the field? "As a starting point, start with the fundamentals," says Daigrepont. "Your options should be squarely based on vendors who are viable, qualified, have good track records, designed for your specialty, that have references they can provide you with to demonstrate what is actually working successfully, etc. But my favorite [fundamental] is the vendor willing to treat you as a true partner, and that might even mean being willing to agree to … [financial performance goals] that protect the practice from actually having to pay out all this money on good faith alone."

• Do your homework. Hertzberg advises practices to not only look at several vendors, but also to develop a formal template to evaluate each vendor. "Do not let the vendors put forth the agenda," he advises. "You must say what the system is expected to do, for whom, to solve which problems. Start with the problem, not the solution. Vendors work the opposite direction."

• Determine local vs. hosted. Health IT consultant and California-based family physician Robert Rowley says one of the first decisions for medical practices needs to be whether  to try and install your new system locally or use something that is hosted remotely, likely in the cloud. This is particularly an issue for small practices, he says, that are not big enough to hire an IT person to manage installation, ongoing maintenance, upgrades, etc. "… There are good, robust Web solutions in the marketplace now," says Rowley. "So there are viable options for smaller practices [that] don't want to [take on] the burden that comes along with hosting something locally."

• Don't be afraid of something new. Sure you are familiar with your current vendor's screen layout and applications, but don't feel like you are confined to just the upgraded version of your current practice management system. Your vendor may not be able to meet the ICD-10 transition date, for example. "So sometimes you might have to sacrifice your preferred vendor choice over a vendor who is more capable of meeting deadlines so you don't compromise the practice," says Daigrepont. Likewise, he says be willing to "sacrifice" your attraction to a look or feel of a product for one that will help you the most. "Do you want the system that looks the nicest or the one that will be compliant?"

• Consider "nice to haves." Once you've reviewed and narrowed down the field of fundamental needs, says Daigrepont, you can add some "nice to haves," things that might be tiebreakers between one vendor or the other. "These are things like [whether it has] an integrated EHR and patient portal, does it have analytics, can it do dashboard reporting, and does it already integrate to my practice's devices," he says. "We can all agree that in terms of transportation, an automobile should have four tires, but some cars have heated seats … sure we can drive around without them, but in terms of deciding what we might prefer, those extra features might come to help you make the final decision."

• Assign a project manager. Find a person at your practice that can devote adequate time to the selection and implementation stages of using a new practice management system. Hertzberg notes this person "must command the respect of future users."

• Mind your costs. There's more than just the cost for the new system. Be sure to build training costs into the overall cost of ownership of your new product, advises Hertzberg.

• Find a champion. On that same note, if the system is aimed at administrative users, find a champion from that constituency, he says. If the system impacts physicians, find a physician champion.

• Get compliance reassurance. "If the whole reason for switching is that your current vendor isn't compliant [with ICD-10 or another standard], switching to one [that is] also not compliant or that also won't be ready isn't a good idea," says Daigrepont. "Get something concrete in writing that stipulates potential penalties or performance guarantees."

• Get a second opinion. Daigrepont's firm offers no-cost contract evaluations on possible pitfalls and areas to adjust prior to putting pen to paper. "I'd really encourage [practices] to get a third-party opinion or someone who is knowledgeable of vendor contracts to review what they are about to sign and commit to," he says. "Vendors make a lot of promises and demos are very slick, so I think it would help to have a third-party, non-biased expert to provide input."

After the switch

After you've signed a contract with your new practice management system vendor, there's still the issue of implementation. And yes, while many claim this timeframe will be short and seamlessly fit into your work flow, that's not always the case.

"Be skeptical of that claim," says Hertzberg. "The biggest problem is that the costs related to low productivity during the transition are so difficult to quantify that vendors can get away with pretending that they don’t exist. But they do, and this is particularly problematic for clinical staff."

His advice: Don't cut corners in training, especially when it comes to physicians, who will sacrifice their productivity - the driving force of practice revenue - to train on the new system.

Daigrepont adds that you'll also want to test claims submissions prior to your go-live date with the new system to avoid hurting your revenue stream. Also consider "post-life optimization," such as creating a plan to advance your use of the system and all its functions.

"Typically, you want to plan 90 days to 180 days for a transition period to really settle in, work out the bugs, work out the kinks, and really get comfortable, and feeling like the new system is working as smoothly as the old one was," Daigrepont says.

Keith L. Martin is group editorial director for Physicians Practice. He can be reached at keith.martin@ubm.com.

This article originally appeared in the May 2014 issue of Physicians Practice.