Tech Tricks at Your Fingertips

Have your children ever asked for a new video game despite the fact that they've barely touched the last 10 games you bought them? If so, you've probably told them to play with the games they already have. Kids rarely take full advantage of what's already at their disposal.

But neither do medical practices. We are often so busy looking for the latest technology solution that we forget to make use of what we already have. Take a few minutes to look at your practice from the perspective of a frugal parent, rather than as a consumer hunting for the hippest new thing. You may be surprised at how capable and advanced an office you really have.

Take simple software further

Nearly every office has a copy of a word processing tool, such as Microsoft Word. The medical secretary may be using it to transcribe dictation, but word processing has other, less frequently used functions, too.

For example, look for ways to save time and overhead by using macros and templates. Essentially, by using macros, staff or physicians can type in one shortcut key to add text or do formatting that otherwise might entail lots of typing and mouse maneuvers.

Templates let you create a standard document you only need to modify slightly for each new use. Imagine a pre-written appeal letter for your most common denials; just add the particulars of each case to appeal instead of typing up a new letter each time. You can easily find out how to use macros or templates by using the help function embedded in your word processing program or reading your now-dusty manual.

Here are some other ways macros or templates can help. Create standard openings and closings to correspondence. Staff can add them to documents with one keystroke. Most physicians handle some types of visits over and over. Create a template for those services, including all the basic information. For example, you could create a pediatric template for well-child visits that includes a place to note the child's weight, head circumference, and all the major systems reviews. A medical secretary or transcriptionist then has to add in only the custom information, instead of typing over and over again on each child's record that the patient's skin color was normal and eyes clear. That saves keystrokes, time, and money.

In fact, one gastroenterologist I worked with slashed his transcription costs by 35 percent, simply by developing half a dozen templates with his secretary.

Share information

Now consider what happens to that transcribed document. Most likely, your secretary prints the transcribed report and files it in the paper chart. Consider the staff time saved if, instead, the telephone triage nurse had network access to those electronic reports -- no more scurrying around the office looking for charts on the physician's desk, in the "to be refiled" stack, or the backseat of the NP's car. If your secretary saves the transcription to a shared file on your network server, and your telephone triage nurse has a PC on that network, your staff has immediate access to office notes without pulling the patient's chart.

Studies I've conducted prove that this simple sort of access to office notes can save a single physician practice an average of $330 per day --  money otherwise spent chasing paper charts. And the real bonus is the timely handling of patient calls and the high level of satisfaction for your patients.

You can use your internal network for documentation and routing of telephone triage, too. Using a simple spreadsheet form, your telephone triage staff can document a call, route the form either electronically or to a directed printer in medical records, document the follow-up and save the form electronically for future access. Your triage nurse will tell you how beneficial it would be to pull up the last telephone documentation when a patient calls in to the practice.

Your staf can share nonclinical data, too. Put your payer contact list on your server, including the names and phone numbers of provider relations representatives. Or create payer network lists with the appropriate labs and diagnostic centers and network physicians. With the right information at their fingertips, staff will no longer refer patients inappropriately, and you won't hear from disgruntled patients who have been shuttled through the healthcare network.

Use your management tools

Practice management software is the most underutilized tool in medical practices. Physicians invest heavily in this technology but get complacent about using all the bells and whistles they pay for. It's like buying a Corvette but only using it for quick jaunts to the local grocery store. Make sure you are taking full advantage of the features your system offers. For example:

Practices lose revenue and impair continuity of care when patients miss annual exams and routine recalls. You probably don't want to schedule annual exams a year in advance --  patients will forget about the appointment and provider schedules will likely change. But you can use the recall or reminder feature in your patient appointment-scheduling module to get control of the recurring revenue opportunity of preventive healthcare visits. Book a recall visit, and your system will produce a list or even a letter to contact your patient for that return visit. Impress your patients with the same kind of service and attention they get from their car dealer's service department.

You can further improve patient service by querying your system to identify patients who have not been in for a year and do not have a future appointment scheduled. In fact, you can use the report management system to identify patients with a specific diagnosis who have not been followed in a specific period of time. For example, you can list all the diabetic patients who have not been in for diagnostic testing in the previous six months. Routine reporting to monitor patient compliance will demonstrate a higher standard of care when it comes time to negotiate payer agreements.

Some practices also use the scheduling modules to generate encounter slips and improve workflow. When a patient checks in, print an encounter slip at the nurse station. That lets nursing staff know the patient has arrived, smoothing over front- and back-office bickering, and avoiding wasted steps or complex lighting systems.

Don't forget about billing and collections. Are you storing expected payments from your key payers for your top 10 procedures? With a payment profile built into your system, you can analyze reimbursement with monthly exception reporting, rather than relying on your payment posting staff to eyeball explanation of benefits (EOBs) for unusual payments and adjustments.

Another underutilized function of practice management systems is the letter merge capability. You can develop a customized letter to request credit card authorizations for unpaid balances from your patients early in the billing cycle, rather than as a last resort six months after the end of a statement cycle. The letter merge function is also a tool for template letters for payer follow-up on claim review requests.

Practice management systems can generate a number of standard (but largely unused) reports. Here are a few examples of data that can be tracked and will help your management team:

• Monitor billing and front desk staff productivity
•  Track missing encounter tickets
• Identify patients who are no-shows
• Analyze claim denials
• Track trends in payer mix variance
• Track trends in provider productivity by RVUs
• Monitor days in accounts receivable by payer
• Analyze procedure mix by provider
• Monitor ancillary revenue
• Monitor referrals by payer or by diagnosis

Talk to your vendor

Finally, make sure someone on staff attends user group meetings hosted by your practice management system vendor. In addition to learning what new features and functions will become available, the meeting provides an opportunity to discuss how other practices are using the system. It's a great chance for new employees to be trained by the vendor, where full system capabilities are discussed, rather than learning only the shortcuts (and bad habits) from fellow staff members. These meetings also are a good venue to voice your needs for future development and to gain support from fellow users.

And your practice management system vendor may have an online forum that can be a tremendous source of expertise acquired by other users for you to access as questions and issues arise in your practice.

Get wired - simply

While we hear so much about fancy, wireless, and expensive communication tools, simpler versions --  that you may already have -- often work as well.

Consider how often physicians in your practice leave the exam room to find a nurse to request a test or an immunization or a medications sample for a patient. With a PDA (personal digital assistant) and a simple form (see the sample Provider Flow Sheet on this page) developed for it, the physician can instead transmit an order to the nurse station printer wirelessly --  without ever leaving the exam room --  which translates to a more efficient encounter and optimum use of the physician time.

Are your providers connected to the practice via digital pagers? If so, staff members can use e-mail to page them with complete messages that permit simple responses instead of a call into the office. These two-way pagers are time-savers and great for call documentation. They work well to keep the practice and physicians always in touch and in the know.

If you associate technology with capital expense, think again. Most practices have more tools available to them than they ever consider using, and most of them don't cost a penny more than the practice already has spent. So go ahead -- dig into that user manual, explore your system functions, go to that vendor conference, take advantage of simple, widely available wireless solutions. It's all there at your fingertips.

Rosemarie Nelson, MS, has experience as a medical office manager, in information technology, and as a consultant to physicians and practice professionals. She was manager of the multi-manufacturer Office of the Future project and serves on the board of the American Heart Association North East Affiliate. She was awarded the 2000 Professional Achievement Award by New School University, Robert J. Milano Graduate School of Management & Urban Policy, and has written numerous articles on practice management issues. She can be reached at editor@physicianspractice.com.

This article originally appeared in the January 2004  issue of Physicians Practice.