The Doctor is (Logged) In

By Gerry Blackwell | Posted April 18, 2007

The beauty of Web-based software is that even very small businesses can use programs with features that — in the past — only big businesses could afford. Software-as-a-service (SaaS) products that manage all or most aspects of a business are emerging now in virtually every major vertical market — even private practice medicine.

Dr. James De Meo of Carolina Podiatry PC in Scarsdale, New York started using AdvancedMD, a comprehensive practice management and patient records system, two years ago. He says the program has transformed his practice. “The biggest thing it’s done is save us time,” De Meo said. “I’m able to use my time more efficiently, and that turns around into better patient care and more profit.”

The latest version, AdvancedMD 5.5, adds useful new features, including an executive dashboard that provides a snapshot of De Meo's practice every time the doctor logs in. As a beta-test customer, De Meo is already using most of them, and he’s enthusiastic. The new features “blow AdvancedMD into the stratosphere,” he said.

Despite the fancy firm name, De Meo is in fact a solo practitioner. His practice is trauma and reconstructive surgery of the foot and ankle. He sees about 90 to 120 patients a week in the four days he spends in his office. The rest of the time he works out of a local hospital. De Meo employs two nurses, an administrative assistant and a receptionist at the office.

When he first hung out his shingle in the mid-1990s, the good doctor did everything by hand on paper — insurance claims, patient records, billing. Many private practice doctors still do it that way. When computerization began to trickle down to the medical profession, De Meo bought a server and a program called Knowledge is Power, a Macintosh-based, first-generation practice-management product. It did the job but was always a headache.

Then two years ago as health insurance companies began ratcheting up the pressure on doctors to file claims electronically, De Meo went looking for a better solution. “It would have been too costly to get software people in to update [the old system to do electronic claims filing],” he said. “The server was temperamental anyway and to get an IT person to look after it would have been too expensive.”

Saving IT Costs
He soon discovered the Web-based SaaS offerings and immediately recognized their benefit for a small business like his. “It costs me nothing to maintain the hardware and software. They do all the updating and upgrading and backing up. I was trying to keep costs down — and money was literally hemorrhaging out of my office — so the Internet-based programs were ideal.”

AdvancedMD is fairly expensive — De Meo pays “about $500” a month — but it’s worth it, he said. It includes both practice and patient records management functions. AdvancedMD manages appointment scheduling, new patient intake, billing and insurance claims, and it puts comprehensive patient records online where doctors can access them wherever they have Internet access.

One reason AdvancedMD is worth it, De Meo said, is that the company provides support 24 hours a day, seven days a week. “Any issue I’ve had has been resolved within five minutes. In the past when my server crashed, it could take 24 to 48 hours just to get somebody out to look at it.”

He’s also thankful that AdvancedMD looks after backing up his data and keeping it secure. The company uses a fail-safe procedure that backs up data every hour to two secure facilities. This more than complies with HIPPA (Health Insurance Portability and Accountability Act) regulations, which mandates that doctors preserve patient data and keep it private. It’s also a huge load off his mind. De Meo always backed up the data when he maintained his own server, but it crashed on more than one occasion and because he was only backing up daily, the most recent data was always lost.

Accessible Anywhere
A lot of AdvancedMD's key benefits relate to the fact that De Meo's practice and his patient records are now accessible anywhere he has an Internet connection. De Meo is typically away from the office more than a full day a week, usually at the hospital. If a patient calls in asking for a refill on a prescription, for example — and Murphy’s Law says it’s more apt to happen when he’s not in the office, he said — he can now write the script online and send it to a pharmacy.

“Especially with me being a surgeon and not in the office all the time, this has made my life very, very easy,” he said.

He also uploads X-rays and test reports to patient records and has them available anywhere. De Meo once met a patient at a Little League baseball game who asked him what a recent X-ray showed. The doctor was able to pull a laptop out of his car, connect wirelessly to AdvancedMD and explain the X-ray to the patient on the spot. “You can put this down,” he said wryly. “Dr. De Meo suggests not practicing where you live.”

The flip side, though, is that online access to patient and practice records helps him better balance work and home life. De Meo has a wife and two young sons. In the past, he often worked late at the office because it was difficult to work anywhere else. He could theoretically access the server-based system from home, but the connection was never reliable enough. Now he gets home earlier, spends time with his family, then goes back to work in a home office. “This has made my wife very happy,” he said.

Online access to patient records also means that his not-quite-fulltime billing clerk doesn’t have to work at the office anymore because all the billing records are available over the Internet. De Meo has converted the space that person used in the past to a radiology room with “hospital-quality” X-ray equipment that brings in an estimated $10,000 to $15,000 in additional revenues every year.

Insurance claims are usually a huge headache for private practice physicians. If they don’t fill out the claims forms properly, with all the correct codes for procedures, the insurance company will reject them — which means more work making corrections and delay in payment. AdvancedMD’s “claim scrubber” features are a marked improvement over those in Knowledge is Power.

“With AdvancedMD, I’ve had a 95 percent rate of first-time success [submitting claims],” De Meo said. “That’s phenomenal compared to the other software. With it, I typically had about a 50 percent success rate.”

New Features
Now every time De Meo logs in to the new version, the executive dashboard gives him a snapshot of the financial status of his practice, updated daily. He can set it up to show month-to-month, year-to-year or date-to-date comparison.

A new scheduling wait-list feature lets a patient camp on an appointment slot. If the original patient in that slot cancels, the system automatically schedules in the waiting patient and initiates communication to let him know he’s been booked. “The patient is happy because he got [the appointment time] he wanted,” De Meo said. “And I’m happy because I don’t have a blank space in my calendar.”

He also likes a couple of the new billing features. One allows him to bill insured patients separately for items not covered under insurance — such as print-outs of X-rays, which more and more patients are requesting, and for which De Meo charges $25. Now his office can send a bill directly to the patient and track it.

The other new billing feature lets him put a hold on an account if he knows the patient has just been laid off or is otherwise temporarily unable to pay his bill. When an account is on hold, the system won’t automatically kick out bills and reminders or send it to collection. De Meo is fond of noting that medicine is also a business, but there is also a human element in medicine that's missing from many business dealings, he said.

“You see him [the patient] in your examining room. You know he’s a nice guy; you don’t want to hound him for collection. This feature adds a more humanistic approach.”

De Meo says that AdvancedMD was relatively easy to implement, even though he had to first print, scan and upload existing patient records because the old system was Macintosh based and the data couldn’t be converted to AdvancedMD’s format. That took three or four days. It took a little longer to learn all the advanced features and get over his initial fear that he could somehow break the system by pressing the wrong key. “But I’ve used AdvancedMD for two years now,” he said. “Now it’s a piece of cake.”

Not every small business will find Web-based software that fulfills all their needs as well as AdvancedMD does De Meo’s, but the software-as-a-service paradigm ushered in by pioneers such as SalesForce.com is now in full swing. If you haven’t already looked into a SaaS solution for your business, you probably should.

Based in London, Canada, Gerry Blackwell has been writing about information technology and telecommunications for a variety of print and online publications since the 1980s.

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