What Not To Do

What are the dumbest, biggest, and most common mistakes practices like yours are making with technology right now? What minor changes could you make -- without spending a lot of money -- to make your life easier?

To find out, we asked Rosemarie Nelson, a well-known healthcare technology guru, consultant with the Medical Group Management Association, and occasional contributor to Physicians Practice.

Physicians Practice:What are the mistakes that practices you consult with make repeatedly in buying and integrating new technology?

Rosemarie Nelson: The biggest mistake is not reference-checking -- not talking to other practices that have implemented that technology, because they very easily take everything they hear during the sales cycle for granted. People aren't necessarily trying to deceive them. But there's more depth to the dialogue that a new buyer doesn't necessarily know enough to ask about. And you learn about that depth by talking to experienced buyers, who bought that product, implemented it, and made their own mistakes. Another big mistake? It's that they don't believe it will happen to them. It's like they keep making the same mistakes someone else made.

PP:You mean, even when they do check in with other practices, they don't believe what they're told?

RN: They say, "Oh, that's not like us. We're better than that." Or, "We'll figure that out." Or, "Oh, we can resolve that."

PP:So is it a case of not knowing what they don't know?

RN: It's exactly that. It's hard to understand how to adapt to that. Every practice thinks they're unique, and to some degree they are. But they do have to try to find some of those standard things that happen, look at how other groups do it, and say, "You know, maybe there is room for improvement in our practice."

PP:Like what?

RN: Well, the other big mistake is that they don't take advantage of the technology they have. The grass is always greener with some other tool. Across the board, practices underutilize their practice management system (PMS). They can do so many things they don't take advantage of. Groups will have patients fills out a little postcard for when they want their annual exam reminder. The PMS has a recall feature, so why not use that instead?

PP:Can they use their practice management system to glean useful clinical information, or do they need an EMR for that?

RN: A lot of practices think they need an EMR. But in fact, the PMS can provide them a tremendous amount of information about clinical quality. For instance, they could query their PMS to find out how many of their diabetic patients did they do a podiatrist's referral on. How many of their female patients over 18 had a Pap smear? There's a tremendous amount of information in their PMS that is underutilized.

PP:Why is that?

RN: To some degree, I think they don't know, or they've forgotten, that their existing technology can do all these things. What's typical in most system implementations -- regardless of the system, whether it's a PMS, EMR, or whatever -- is that they implement to take care of the basics first, and then they don't go back to revisit it. "We absolutely have to get bills out, we have to post payment." But once they get that comfort level with the new system, they don't then say, "OK, we've overcome that hurdle, now let's go look at the next phase. Let's see what else we can do."

PP:Don't the vendors push them to do that?

RN: No. Because once the client is past the initial set-up, and they're happy and everything is going OK, the vendor is off to their next client. That's understandable. It's one of the reasons I suggest to practices that they include in their contract a revisit with the vendor three months and six months after they're live. The vendor can come back and say, "Here's what you're not using." Include this in the training. Don't try to negotiate away training and implementation services. They will pay for themselves in the long run.

PP:How much does simple human nature come into play here? Don't people often just give up on something when it doesn't seem to work right immediately?

RN: Technology is so frustrating when it doesn't work. Even with something as basic as Windows, every once in a while something happens and you have to reboot. You don't know what happened or why, but once you reboot it takes care of itself. When that stuff happens, it's so frustrating, and that's when we start cursing out Bill Gates and all his money. It happens with practice management systems, too. Technology doesn't work perfectly every time, so when something goes wrong, it sticks in our brain, and we start to resent the vendor. Rather than trying to figure out how to work well with the vendor, we give up on them and go look for someone else. Meanwhile they've already paid for everything and now they're not getting what they paid for. It's like buying a car and never using the cruise control, because you just didn't know where the button was.

PP:And these sorts of systems touch on so many aspects of the practice.

RN: Right, it's cross-functional. What happens is you have one person who kind of spearheads it, and maybe that's your business office manager. And that person is focused on what they need, but maybe there's no equivalent person in the front-desk area, so maybe they don't push the appointment scheduling envelope. And maybe the reporting tools aren't as easy as they could be, so what happens is people give up on those -- yet there might be someone in the billing office who's figured out how to really make that report right at home. But someone at a satellite site or in scheduling doesn't even know whom to ask. It's a cross-functional system, but we haven't figured out a cross-functional implementation process. There's usually no one whose job allows them to have the time to think about how to take advantage of these tools.

PP:But that's just the nature of practice, isn't it? What can they do about that?

RN: Enlist some outside help -- someone whose sole job is to see that they use everything. It's a great thing to treat yourself to a technology assessment on an annual basis. Let someone come in and say, "Are you using what you've got effectively? And if you're not, what could you do differently?" Someone just spends a day walking around and observing.

PP:It's not always about making major changes, or total technology overhauls, right?

RN: It could be something as simple as a fax machine. Some people have these fax machines that just spit out paper. Why not go to digital fax? Maybe there are some things you don't need to print. In general, you need someone whose job it is to stay current on technology. Healthcare technology changes very rapidly. And physicians get how many journals a month? And how many can they read?

PP:Some practices do have in-house tech gurus, don't they?

RN: Some do. And if you do, invest in that. Treat that person like a clinical professional: make sure they're getting the latest tech journals, that they're hooked up to the listservs that tell them about the applications and the latest gadgets that are coming out.

PP:What other big mistakes do practices make?

RN: They think they need a technology wizard who's related to healthcare only. You can probably learn a lot from just a business-networking type of consultant.

PP:So they don't necessarily need someone like a Rosemarie Nelson?

RN: No, someone who can tell them about the things that a network can do for them and what e-faxes can do for them, voice recognition, linking PCs to the server -- that's just plain old business networking. Now, if they're looking to get an EMR, they better get someone who understands clinical operations. But when it comes to ordinary business applications, they are woefully underutilized. You could pick up a phone right now and call 10 practices, and find two that are still using an A/B switch box to connect a couple of computers to a printer, because they're too cheap to create a network. Then there are practices that buy a printer just for the front desk instead of putting a printer on the network. Why are they copying insurance cards instead of scanning them? That's where a business technology consultant can help them. Simple things.

This article originally appeared in the September 2005 issue of Physicians Practice.