Take-Charge Software Helps Manage O&P Practices

It's no news that these are tough times for O&P practices, and if there's a lifeline available to assist you in improving efficiency, developing documentation, increasing security compliance, and reducing paper clutter, it's only sensible to seize it gratefully. Computers are handling more chores in more practices than ever before - even clinical applications - but they are still not being utilized as fully as they could be. Part of the reason is, of course, the investment cost - in dollars and in employee hours spent learning arcane new systems. Since often it is a simple case of not knowing what you're missing, we have undertaken the task of cataloging the capabilities and identifying the sources that can provide them for you. So if you're wondering how new or expanded computer software systems can help you, let us count the ways - and name them, too. NOTE: Identifying common and/or parallel features among the various systems we researched is virtually impossible, making comparisons not only politically hazardous, but inappropriate. It's not so much like comparing apples and oranges as comparing footballs and baseballs; each does its assigned task effectively, and it is strictly user preference which determines the design of the vehicle chosen. Futura OPS Software With the current emphasis on HIPAA compliance for electronic information, every data field of information within an office management software application must be secured. Therefore, control of ePHI (electronically protected health information) is a key feature of Futura's package. This control extends not only to how the information comes out of the computer or who has access to it after it hits paper, but also to how it's controlled within the system. Futura's security features carefully control who can view the information and who can edit it. "In our circumstance, security control is part of the management software developer's responsibility," said Terry Long, president of Futura International Inc., who takes this responsibility seriously. "In addition, we are not aware of any other software company that currently provides PHI field-level control." That control includes role base security levels (for example, supervisor, clerk, receptionist, practitioner), which Long considers a critically important feature of the Futura system; instead of just setting up security levels saying whether you can sign in or access the application, the software ties security limits to every aspect of the application, protecting each one to the level specified (for example, field and record levels). From a clinical perspective, Futura also provides a completely paperless solution. All documentation needs for clinical assessment are, or can be, totally automated. Any aspect for billing or clinical collection of information is done digitally within the system. This includes, but is not limited to, measurement forms, automated progress notes, electronic SOAP notes, clinical outcomes assessment, as well as storage of electronic signatures, digital images, scanning, etc. Futura's system is designed to be deployed within the purchaser's environment. However, Futura also provides an affordable ASP (applications service provider) service. By having Futura host the software, clients are saved the purchase cost of the hardware needed to function at their site, including IT support. Long pointed out that using Futura's ASP service protects clients even better with regard to HIPAA compliance and security provisions. "It actually puts them in a more protected arena because it's off-site and there is no data available in their facility or in their computers." Another advantage of the Futura application is its wireless support capability. Since clinicians and practitioners are using more wireless devices (for example, PDAs and PC Tablets), the Futura application enables the clinician or practitioner to remain mobile in a wireless environment. Since no data resides on these devices while they are out seeing patients, there is no security crisis if the device is lost or left behind, Long pointed out. "They can connect via cellular technology to our server and receive real-time information for appointments, clinical documentation, visual images, without carrying any charts." Recently, Futura released its QuickBooks integration. "Since many facilities use QuickBooks as their accounts payable and P&L application, Futura now enables integration in order to eliminate separate maintenance of the two applications," said Long. Coming Soon: Later this year, expect Futura to integrate its software with the inventory and product information of manufacturers such as Otto Bock. "We are combining their product catalog into our inventory, as we will soon be doing with all the manufacturers," said Long. "All the products will be built into each client's application, so they don't lose time sitting on the Internet or pulling catalogs." Futura will also be instituting a user group forum on its website. This will allow users to interact with OPS professionals and post focused questions or actively help others with tips and ideas for practice management. MedEvolve Statistics are valueless unless you can (a) access them and (b) analyze them. While many practices already receive reports of business activity, receivables, etc., finding specific data for analysis often means manually sifting through a series of printed reports. Jay Davison, president and chief operating officer for MedEvolve Inc., feels that one of MedEvolve's software's primary strengths is its ability to analyze data. "While some systems have report writers on which you can construct a report, they're a bit technical and difficult to work with, and consequently they are not used. MedEvolve's software is quite intuitive. If you need to determine how many diabetic BK patients have received care within the last year, our Microsoft Windows software is equipped to do that. Most of our modules use MS products, so we're not reinventing the wheel; we can pick up and use them as tools to analyze data for the practice." Some other software creators build their own systems, but Davison noted that such adapted systems can be difficult and frustrating to work with. "You spend so much time trying to work with the report writer that you're not spending much time experimenting with the findings. Some of the best research begins with a vague question that raises further questions, which leads you to continuing analysis - drilling down through the data is what we call it. Our tool facilitates that process very nicely for a nontechnical individual." Another advantage of the MedEvolve software is its ability to tie into the revenue stream by streamlining the insurance claim process. Instead of sending claims to a clearing house - which distributes them among the various health plans and usually charges a transaction fee for its trouble - the software allows users to send standardized, HIPAA-compliant claims directly from their system to the insurance entity - for example, Blue Cross. Not only does this expedite the process and eliminate transaction fees, but it limits the number of hands (and eyes) the claims are exposed to, thereby improving security and reducing the opportunities for error. "Claims are much quicker and cleaner," noted Davison, "and if there is an error, it's much quicker to locate its source." Davison expressed the MedEvolve philosophy behind such business decisions, "We want to be known as the software provider with the major profit impact on our client's practice. Even in terms of pricing product, we'll give up a short-term gain in order to maintain and enhance that reputation of being committed to our clients' profitability." MedEvolve also offers outsourcing, but when Davison offers that choice, he offers an effective metaphor. "Would you like a fish? Or would you like us to teach you how to fish?" Often, however, outsourced customers who were initially intimidated by the perceived complexities of computer technology begin to realize it's not so difficult, after all. Using long-distance training through linked computers to illustrate and explain, Davison advances them to an in-house system. "Perhaps 90 percent will initially request the outsourcing, while probably 60 percent, once they're shown how it works, will take it back in-house." Naturally MedEvolve charges a larger fee for outsourcing, but in the long run, it's better to have clients in-house doing their own work. "Because then they get creative, and then they get enthusiastic, and that means they are a more powerful word-of-mouth reference for us." MedEvolve's exclusive Document Manager serves as an electronic patient chart, allowing images, X-rays, EKGs, letters and reports, to all be filed electronically in the patient file. Each item, however, is granted individual security by a system that supports that HIPAA "need-to-know" philosophy. The electronic medical record (EMR) can be widely general or carefully specific. MedEvolve partners with a variety of EMR firms, allowing software users to use an EMR form specific to the needs - for example, O&P. The EMRs can be complex, including security-based medical pathways, but MedEvolve's core design criteria in building the system is to maintain that secure electronic record and be able to pass it around easily, Davidson said. Rather than market separate offerings, "We do have some optional modules, but we tried to package the core applications almost everybody needs," Davidson said. "We're not really designed to serve a very specialized practice that already uses a billing service and only wants a document manager. We're geared for practices that are trying to take care of their entire set of business in-house with their own staffs." MedFlex Specialization is the key to efficiency when it comes to software. Generalized or "horizontal" applications that work for many different businesses have limited value to a specialized business. MedFlex was developed by custom programmers as the response to a need for a specialized or "vertical" software system specifically for O&P. Since its original development for its first client, Becker Orthopedic, nearly two decades ago, MedFlex has naturally evolved with the times and in the direction of greatest demand, using rapidly developing technology as soon as it is available. "When we first started," explained John Mason, president of MedFlex, "computers weren't capable of storing a gait analysis video, and the hard drives were much smaller. At that time, a $5,000 hard drive held 340 megabytes; now, $80 buys a one-gig card for a digital camera." And since software capability is contingent on the existence and affordability of hardware to support it, MedFlex is perpetually adapting new solutions and systems. Mason points out that clinical software applications are relatively new, because previously no appropriate hardware existed to handle them. As a system grounded in systems design and database experience, MedFlex's foundation has previously emphasized its strengths: for example, integration of all business functions, including HIPAA-compliant billing. How important is it to offer both administrative and clinical aspects in a software system for an O&P practice? Critical, Mason believes. "Otherwise you have people duplicating information indiscriminately. "The reason a number of people pick our software is not only because it has the clinical information and the business side covered, including electronic submission, but we also have inventory, purchasing, general ledger, wip, and payables. We're the only one in the medical field that has all of that. With other systems, people run accounting systems that are separate from their billing system. From a small business owner's perspective, this lack of integration creates a weak point of control. Most people have a mess, and they don't know where they stand until the accountant tells them a couple of months after the fact." MedFlex affords its users strong point of control, so people can reconcile to their bank every day if they want, via phone or Internet, Mason said. "In our world, the owners can touch a button and know what their profit-loss was that week, compared to any other week in their history." From a clinical perspective, maintaining patient records can become complex if the user's software only allows for one set of demographics per patient, as is the case in systems that are billing-focused. If no allowance is made for multiple registrations in the database, what happens to the patient who is first a hospital-treated accident victim (with the hospital as guarantor), then is referred to your practice by his therapist (as his own guarantor)? Two - or more - separate records for the same patient? If so, how do you locate clinical information stored under multiple patient numbers? MedFlex allows multiple layers and multiple registrations under the same patient number, maintaining the integrity of the patient record and eliminating problems and confusion. The marriage of clinical and billing information in this manner provides a comprehensive picture for later reference, and constitutes vital documentation. Another unique MedFlex feature is fee-analysis summary. Scanning a year's worth of data may produce a report 6,000 pages long. By previewing CPT rankings, however, users can determine what's driving their business, seeing the percentage of sales for specific L-Codes, and selecting the few pages that are important enough to print. For most O&P businesses half the business is documented on the first page of this report. Also covered in the analysis is the success rate for claims submissions, including the number of times Medicare non-assigned claims were submitted, contract amount, and disallowed; and also current Medicare amount received, including patient portion. This produces a bottom-line percentage that identifies how far over or under Medicare allowables reimbursement has been, and helps create a clearer picture of what is making or breaking the business. MedFlex's open-box format for clinical information also allows users to add to the system any tools they have already developed or used in-house, in addition to pre-programmed choices. These can include CAD, spreadsheets, voice files from PDAs, PDF files, electronic forms, or any Windows-registered application. Storing and backing up all these large files isn't a problem, claims Mason, due to Medflex's method of burning historical data into optical storage via date selection, along with a utility that allows the user to move information to an external hard drive and add unlimited stacks of hard drives which are still readily accessible. Among multiple other analysis potentials offered by the system, performance by practitioners can be tracked. MedFlex assigns practitioners to jobs, rather than to patients, since patients are often seen by different practitioners on different occasions. Patient satisfaction surveys and follow-up reports are also well-covered; even thank-you letters can be automatically generated to referring physicians as well as physical therapists or any other relevant marketing source. "And since we wrote our scheduler from the ground up, it also contains unique features and is highly integrated with our software, not an afterthought," Mason said. The scheduler starts and tracks the jobs, generates the charge tickets, manages clinic assignments, and interfaces with the collections job to message or prevent patients being scheduled that have ignored collections issues. Parts and supply ordering systems also boast special features, and for businesses with multiple locations, the MedFlex system seamlessly integrates all locations within the same data set, including controls and security appropriate to separate sites, Mason noted. MedFlex builds systems and assists clients to connect with an appropriate server, but does not offer hosting service. Most of Medflex's clients run the software over the Internet with 128-bit encryption, because they have multiple offices. "If we handled central hosting and we lost our Internet connection, then we'd have 600 O&P offices around the country go down," Mason pointed out, not a risk the company is willing to take on behalf of clients. Using "thin client" software, MedFlex customers can, however, receive online-linked educational support in real time via any PC with an Internet connection. The standard "thin client" from Microsoft is 128-bit encryption out of the box, Mason explains. Coming Soon: "Because many of our clients have been clients since the 80s, our system evolved on what is called a peer-topeer database. We are moving toward a free SQL-based system with worldwide support, so our small clients won't have to pay the big bucks to migrate to this more flexible database platform. Once we're in that platform, that will allow people to do more things with their software utilizing more levels of integration in the future; it would allow us to come up with, perhaps, an appointment-request web page for patients who can interact right with the main database, and a method of e-mailing an appointment confirmation to the patient. "I think that level of integration in using wireless Internet will continue, and more capabilities will come because of that. We can already do some of that now." Mason notes with pride the success of many of the company's clients as they have grown and added offices and become dominant in their geographic O&P market. He hints that Medflex's involvement at the ground-floor level on a new and growing venture will be making news soon. OPIE OPIE (Orthotic & Prosthetic Information Expert) holds the distinction of being created from the perspective of an O&P practitioner and business owner. As one of the newest kids on the block, OPIE's development began in 1999 when Paul E. Prusakowski, CPO, FAAOP, president of oandp.com, decided to create a digital system to monitor and manage paperwork related to the patient care process. This first step was taken with a larger goal in mind: to create a system that completely integrated all aspects of the clinical practice management process - increasing efficiency, reducing the margin of error, enhancing communication, automating processes, and providing complete documentation throughout the entire process. "To create a comprehensive, integrated system," said Prusakowski, "we needed to recognize and address the unique roles of various individuals within the practice. Thoroughly understanding workflow needs in the dynamic environment of an O&P practice was essential. While individual software tools were already promoting efficiency, we knew that the most substantial time savings would be realized when the entire process was tied together seamlessly to allow the practitioner to manage all aspects of patient care with as little friction as possible." The result of their efforts is the OPIE Practice Management Suite - an integrated collection of software tools developed for practitioners and technicians as well as for clerical and billing personnel, helping them to automate and organize the entire practice. Although Prusakowski noted that the billing and collections module is not yet available, when it is released later this year, the full suite of tools will handle electronic medical records, fabrication management, purchasing management, scheduling, documentation, electronic billing and collections. "OPIE is considerably more than billing software with a few added features," said Prusakowski. "We've approached it from a completely different direction, and the result is that everyone in the practice uses and benefits from the OPIE Suite. This also means that the business owner has a better view of what is happening in his/her practice, because it is all tracked in one integrated system that provides detailed reports." Prusakowski also noted that OPIE integrates with the Internet-based tools that oandp.com has developed, including different technologies designed to help a practice and a practitioner run more efficiently. "I think what truly differentiates us is the combination of a practitioner-centric approach and an expert software development team that knows the industry," he added. "This was my baby, not a billing software company's invention, and we sought input from leading O&P professionals to ensure that the software would meet their needs. Our team has been developing Internet-based tools for this profession for nearly ten years, so the extension into O&P practice management software was natural for us." With the new billing and collections module still in the beta testing phase, an OPIE Suite client would of necessity be running some parallel systems until that module is available on the market. The current software provides an operating system for running the entire practice, minimizes administrative overhead by feeding the billing persons the information needed to enter into their billing software, and simultaneously creates complete documentation of events on the clinical side. OPIE is also developing interfaces that will allow its clinical management software to work with some billing software systems, offering clients greater flexibility. Purchasers of an OPIE Suite set up their computer network with a local specialist, and the initial software installation and training are done remotely, although OPIE does offer "for-hire" onsite visitations, if requested. Including users of the OPIE Lite version, a free-standing purchasing management piece, Prusakowski estimated that about 40 companies are OPIE clients, representing close to 70 office locations. Once the eagerly awaited billing and collections module is complete, he anticipates doubling that figure within 18 months. "The complete OPIE Practice Management Suite will integrate all aspects of the clinical practice, providing software tools for everyone in the office, giving the owner/manager/ practitioner complete control of all information, significantly reducing paper and streamlining processes, and raising accountability for everybody involved," said Prusakowski. Coming Soon: OPIE is integrating with a growing list of companies to provide electronic catalogs and direct electronic ordering from within the software. Companies already on board include Ohio Willow Wood, College Park Industries, Kingsley Manufacturing, Prosthetic Research Specialists, and O&P 1 , with more on the way, Prusakowski said. This next level of integration between provider and supplier offers welcome benefits to both. For more information on the companies mentioned in this article, visit: Futura International Inc . , 22051 U.S. Hwy 19 N., Clearwater, Florida 33765; phone: 727.791.3332; fax: 727.726.7164; e-mail: sales@futuraintl.com ; www.futuraintl.com MedEvolve Inc. , 17300 Chenal Parkway, Suite 301, Little Rock, Arkansas 72223; phone: 800.964.5129 ext. 301; e-mail: jay.davison@medevolve.com ; www.medevolve.com MedFlex , 314 Buckingham Dr., Lafayette, Indiana, 47909; phone: 800.728.7936; fax: 765.471.9961; e-mail: johnmason@MedFlex.com ; www. medflex.com OPIE , 6830 NW 11th Place, Suite 1, Gainesville, Florida 32605 3870 NW 83rd St, Gainesville, Florida 32606 ; phone: 800.876.7740; fax: 352.332.0161; e-mail: opie@oandp.com ; www.oandp.com/opie Companies mentioned in this article are included for reader information only. This is not a complete list of companies producing medical and allied health practice management software. The O&P EDGE does not endorse any specific companies, products, or services. Judith Philipps Otto is a freelance writer who has also assisted with marketing and public relations for various O&P industry clients. She has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer.

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