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A Winning Combo

October 1, 2005
by Frank Jossi
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Small clinics see big gains in teaming up practice management and medical record systems.

Lowell J. Kleinman, M.D., has made a pretty good name for himself as a nationally known antismoking advocate and co-author of The Complete Idiot's Guide To Quitting Smoking. But Dr. Quit, as Kleinman has been called, is also a savvy technology consumer, having traded in his physician practice management (PPM) software last year for a new integrated package featuring an electronic medical record (EMR).

"The old software could interface with a couple of EMR vendors, but most of the EMRs I looked at came with their own practice management software," says the solo general practitioner and owner of Family Practice of San Ramon, Calif. "I had a very specific need for an EMR and a practice management system built on the same platform, as opposed to being tacked on to other ones. I wanted a fully integrated PPM-EMR with good note-taking capability."

Kleinman gained a great deal of buying knowledge through hearing lectures and participating in online forums sponsored by San Francisco-based Lumetra, California's quality improvement organization. Lumetra has a federal government contract to assist small and medium-size practices in selecting EMRs by offering advice on choosing vendors, implementing systems and improving care. Kleinman ended up buying a PPM-EMR software package from eClinicalWorks, Westborough, Mass.

A sweet suite
The addition of an EMR is the newest wrinkle in PPM software. Some EMR vendors have added PPM modules or purchased practice management companies. Some PPM vendors have done the same thing in reverse, buying EMRs or building their capabilities into current software suites, reports industry veteran Gary O'Gwen, president of software vendor MDanywhere Technologies Inc., Baltimore.

Only about 15 percent of the more than 70 percent of U.S. physicians in small or solo practices currently use EMRs, according to industry sources. Vendors of integrated solutions point to a variety of benefits, such as a common registration process covering all aspects of billing and care, improved workflow and simplified training.

For example, any changes in a patient's record will update that individual's entire record through the EMR and PPM modules. Data no longer has to be entered twice. Doctors and their staffs learn how to use just one common interface for recording and reporting financial and care data, notes O'Gwen.

Neil Simon is COO of Mountain View, Calif.-based iMedica, which sells an integrated PPM-EMR known as PhysicianSuite Patient Relationship Manager. Formerly, iMedica sold a stand-alone EMR, but this year it added practice management to the solution to attract physicians looking for software capable of more functions. Scheduling with practice management, common today, could not be done in the early 1990s, says Simon, but "You couldn't sell physician management today without scheduling. And in the future, you're not going to be able to sell practice management software without a clinical management system. The combination will be like customer relationship management software is in the business community," he predicts. "This kind of [PPM-EMR] software is paving the way."

Antonio P. Linares, vice president of medical affairs at Lumetra and a recipient of Healthcare Informatics' 2005 Healthcare IT Innovator Award, agrees. His organization received a grant from the Centers for Medicare & Medicaid Services a few years ago for a program called Doctors' Office Quality Information Technology (DOQ-IT). It's the program Kleinman participated in before making his decision. "One of the things DOQ-IT strongly supported was that EMRs must interface with a practice management system," says Linares. "I don't know of any practice in DOQ-IT that had a problem with interoperability with practice management systems, because they were only looking at options that provided interoperability with clinical appointments, scheduling, billing and the EMR clinical component."

Interoperability is still not a reality, says Justin Graham, associate medical director for quality and informatics at Lumetra. Organizations still struggle to get different vendors' systems to work together, he says, even though many vendors attempt to comply with HL7 standards, which are intended to allow healthcare software to share data with minimal programming.

Small physician offices remain wary of technology, says Vincent Hudson, a competitive intelligence expert in physician office and medical information. "They all have an inner voice that says, 'I've got to incorporate technology,' but they don't know what to acquire," he says. "And they don't trust anybody."

Vendors respond
What vendors see in the combination package is a way to satisfy both administrators and doctors drowning in multiple systems and paperwork, says Hudson. For example, Linares found plenty of support from the vendor community. Of the more than 40 vendors that agreed to work with DOQ-IT participants, more than half offered a PPM-EMR solution. And not every vendor with a combination solution signed up to be part of DOQ-IT, he points out.