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Practice management: software vs. humanware

Reiter, Duff

doi: 10.1097/01.HJ.0000396587.97859.d8
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Duff Reiter is owner of Verve Marketing. For a copy of Verve's practice management survey results, readers may contact him at duff@vervemarketing.com.

Think of the sympathetic voice answering the audiology office phone. She, and it usually is a she, also arranges patient appointments by writing them into the front desk appointment book. This book is filled with names, numbers, and miscellaneous information that may or may not be useful to the audiologist who will be seeing these patients.

This front desk employee may also be the one who runs credit cards and keeps track of payments. All of this information eventually finds its way into the company accounts which typically are run through QuickBooks or a similar accounting software program. Welcome to the modern, but not too modern, approach to running an audiology office.

Practice management software originated from managing this front desk appointment book. As individual practice case loads grew, so did the complexity of information that needed to be tracked. Appointments were classified and color coded as hearing assessments, fitting sessions, or cleaning and repairs.

But the front desk person could only do so much. Someone needed to manage the inventory of stock on hand and hearing aids on order. Patient records, histories, and charts needed to be catalogued and filed and more people were hired to handle these clerical functions. Until the mid-1990s, no one thought much about automating these tasks.

Practice management software has been on the horizon for over 10 years now, but until about 12 months ago, there were still legitimate reasons to resist this kind of automation. Most of the practice management software programs did not integrate with NOAH fitting software or QuickBooks accounting software which has become the industry standard for audiology practices of any size. Hence, the idea of adding another software solution that would require double-inputting of patient and financial data seemed counterproductive.

Now, most practice management software fully integrates with QuickBooks, and NOAH integration has begun as well. If there was ever a time to take a closer look at practice management software as an end-to-end solution, now is that time.

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WHAT PRACTITIONERS WANT

Last summer, we conducted a study with audiologists that focused on practice management issues. Responses to this study clearly indicate that software usage as a way to streamline business processes has hit the mainstream. While our study is by no means definitive—we had 300 respondents answer 25 questions—it certainly provided a snapshot of how audiologists are thinking about practice management.

Our questions looked at and compared a variety of factors including: single practitioners vs. larger practices, newer practitioners vs. those with 12 or more years of experience, and practice management software users vs. non-users. Through their answers, the respondents shared important insights into the nuts and bolts of running an audiology practice. Specifically, they shed a bright light on how they view software as a practice management tool, and how they use and track their marketing efforts in all media.

For practice management software users, 37% of the respondents to our survey, it is almost unthinkable to go back to paper and pencil for managing appointments and patient records. In fact, most users are now considering more robust usage of the rest of their software packages.

According to feedback from the respondents, managing inventory and implementation of a patient contact system seem to be the functions that practitioners are most likely to employ next. Christine Diles, AuD, who owns California Hearing Solutions with her husband Bill in Santa Rosa, CA, says that she is still learning the system, but has already found that there are user interface issues that need to be worked out. “Some of the inventory groupings need to be reorganized, as do the automated patient follow ups.”

Patient follow up is a major component of practice management software. Imbedded into the software platform of TIMS, sycle.net, and Blueprint Solutions, among others, is the ability to automatically generate letters and newsletters to existing patients reminding them of check-ups, impending warranty expirations, and new product introductions. Many practices use this function to send out birthday greetings as well.

More sophisticated users group their patients in ways that make it easy to send out customized communications, tailored to each patient's situation. These functions, bundled together, are usually referred to as CRM or Customer Relationship Management systems in marketing parlance. Today, most sales organizations, whether they are the size of IBM or a local widget company, use CRM programs to track their customer contacts.

At least one of the software companies is also testing a lead generation program where the audiologist only pays for leads that are converted into sales. While this may be viewed as a gutsy or even foolhardy move, it makes sense if you consider that their software program already tracks all of the practice's transactions anyway. While you could try to hide the origin of a lead, it's almost more trouble than it is worth.

Traditional sources of leads have diminished considerably, says Mark Sanford of Better Hearing Services in Walnut Creek, CA. “Direct mail response rates have declined to less than a half percent. If a software company can provide leads that aren't just the type to look and not buy, and I'm not required to pay until the viewer converts, then I am definitely interested.”

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INTEGRATING WITH EHR

Another fairly recent development driving adoption of practice management software is the increasing integration of audiological services into Electronic Health Records (EHR).

While you can manage a patient's health records through paper files, it is very time consuming. EHRs are the preferred method of sharing medical records among healthcare professionals, and with this new standard most audiologists have sought a software solution to manage these programs for them.

Only in the last few years has QuickBooks made it easy to integrate their software with other software programs used by audiologists. Up until that point, audiologists had to run separate programs for QuickBooks, NOAH fitting software, and practice management software. This meant keeping three separate databases and entering data into each system individually, but as of this year, NOAH is now fully integrated into most of the larger practice management software services.

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Privacy, security, and consistency

Once issues with data integration were solved, the next major concern became privacy and security. As one respondent put it, “I will never be 100% confident of patient record security, especially in today's world.”

Nevertheless, all practice management software systems now tout a high level of data encryption and security. As a corollary, the programmers also go to great lengths to ensure that there is little, if any, downtime.

Both network-based and web-based software systems can crash. Networked software suffers from the usual software glitches caused by programming bugs and data-overloads, and web-based software will go down when there are internet connectivity problems. While all software providers have worked hard to minimize these problems, they will never go away entirely. Still, one bonus of web-based systems is that updates are much easier to administer, as they are streamed live over the internet as opposed to network updates which are implemented manually via a set of disks.

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GOING MOBILE

Mobile technology has also been a driving force in the development of web-based software solutions. If you're an audiologist who works from multiple locations, being able to check on your appointments via a cell phone is a big time saver.

Several software providers have been working on incorporating mobile devices into their software platform. Others, like sycle.net are already there. According to Ridge Sampson, CEO and co-founder, “The ability to function on the iPhone and iPad is just one of the many benefits that come from having a web-based practice management system. The data you need is no longer chained to your front desk or stuck in an appointment book.”

The iPad has already become a very popular tool in hospitals. The larger screen size makes it ideal for viewing charts and other information necessary for managing patient care. Imagine being able to use your iPad to pull up an audiogram or a patient's NOAH fitting information, and then show it to the patient. Even more than smart telephones, the iPad may be the next technology platform for audiologists.

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INNOVATIONS ON THE HORIZON

While providers are hammering out the details of some of the more technologically advanced user options, they continue to innovate in other areas.

Simply Hearing of Ontario, Canada, has a user interface that is easily translated into other languages. As a result, they have developed a strong following outside of the US, particularly in Asia. Rather than having to hire translators who act as bridges between the software and its daily users, Simply Hearing offers Asian customers a tool that allows them to easily and quickly change over the user interface into the local language.

Most providers also offer tutorials and formal training programs with individualized consultations to assist customers with their adoption of new software. Sycle.net sponsors its own channel on the Audiology-Online website to keep their users up to date on changes and updates to their software. Others, like TIMS, offer a more hands-on approach to training.

“I try to convey to my customers that the software is just a tool. The goal is to use the tool to become better and more profitable audiologists,” says Tom Robbins, senior manager of audiology business development for TIMS.

Robbins uses his website to steer customers and prospects directly to him for a personal consultation. As he walks his customers through the fine points of the software, he also works with them to use the data that has been aggregated into reports to help them make good financial decisions.

Practice management software has reached a point where it has become an integral part of practice management consulting, says Dan Quall of Right Hear Network.

“We insist that all of our network associates adopt practice management software, but in addition to technological innovation and clinical excellence, you also need to provide a path for professional development of your audiological staff and a financial plan.”

The Right Hear Network approach leans heavily on professional training, featuring a community-building portal through their symposia where members can congregate and share ideas.

Bill Diles echoes the importance of having a peer group. He calls his informal group of audiological colleagues his “California Mafia.” One of Diles' claims to fame is being the first customer of TIMS back in 1997. With his long history using practice management software, Diles says that managing his multi-site practice without software is unthinkable. “As we get wiser as practitioners, we rely less on buying and consulting services, and more on tools like practice management software.”

The audiological community ranks peer-to-peer meetings as an extremely important aspect of effective practice management. When asked if they would like to be able to discuss business issues with others in their profession in a neutral environment, 70% of the audiologists who completed our survey indicated that they would. This number was further qualified when we asked where they would be most comfortable sharing information. Over 50% of the respondents indicated that they preferred a website or online forum that is independent of affiliation.

In terms of subject matter for this neutral forum, 68.8% of our respondents indicated that they would like to discuss the benefits and drawbacks of practice management software and tools. This was by far the highest ranking subject for discussion.

Clearly, practice management software has come of age. Those who are using it have access to reports and data that help them make better decisions about how to run their practices, and those who don't yet use it are full of questions for their software-using peers. No longer is it a matter of whether to adopt practice management software, but when and with which provider.

© 2011 Lippincott Williams & Wilkins, Inc.