Hi and welcome to the next installment in our private practice mini-series – today we’re going to focus on using technology in private practice.
This is video 5 of 6 in our series Starting a Psychiatry or Therapy Private Practice:
- Episode 1: The Mechanics of Getting Started
- Episode 2: Income in Private Practice
- Episode 3: Marketing your Private Practice
- Episode 4: Start-up Decisions You Must Make
- Episode 5: Technology in Private Practice
- Episode 6: The Highly Efficient Private Practice
I’m Ken Braslow, and I’m a board-certified child/adolescent and adult psychiatrist. I trained at UCSF, run my own private practice in San Francisco, CA, and founded Luminello, the electronic medical record for psychiatrists and therapists.
There are no other commercial conflicts of interest.
So the goals of today’s presentation are to think through the potential pros and cons of using technology in a few key areas, and then I hope you’ll come up with an action plan to move forward.
We’re going to cover the areas where technology can be most useful, like communicating with patients and colleagues, documentation of clinical encounters, administering a practice, and then how to protect that patient information.
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Let’s start off with discussing streamlining communication in your practice. You’ll frequently get requests throughout the day from current patients just to ask you a quick question, or even from colleagues who want to discuss a patient for just a minute or two.
On the one hand, you want to make sure that you’re not going to miss things over email that you really should be discussing on the phone. So if patients ask you via email for some advice, you should always think about offering them an appointment to discuss things more in-depth. Similarly, finding time to talk to colleagues can actually save you more time than doing e-mails back and forth. And needless to say, you build closer relationships in the process of talking to people.
On the flip side, if all a patient really needs is a simple dosing question answered, or a refill, or to book an appointment, something very straightforward like that, then avoiding a phone call can be very efficient, because once she or he has got you on the phone, it can be hard to get off the phone. You should assume that there’s no such thing as a 30 second phone call, but of course an email can be done in 30 seconds. Email should always be sent securely and be hipaa-compliant – so, not using just your regular email account – and you should think about how you’re going to easily add emails to the chart.
Before you engage in emails with patients, it’s important for you to think about how you are going to handle billing for that time or not. Of course you deserve to be compensated for your time, whether or not the patient is in front of you; however, you don’t want to nickel-and-dime patients.
Now let’s talk about note taking. For some providers, using pen and paper, or programs like Microsoft Word, could work fine.
Using pen and paper is of course the simplest method, but what happens if you spill juice on your notes? And there’s no copy and paste, or clone forward, when you are using pen and paper.
If you’re using Word, this is stored on your local computer, but what if your hard drive crashes – do you backup regularly? What if your computer is stolen – is your hard drive encrypted, not just password-protected? And Word is also, just Word – what about integrating other clinical elements of the note, like rating scales or patient questionnaires into your notes?
On the practice side, are you okay using multiple systems like one for scheduling, one for note-taking, one for email, one for billing? For some providers, that’s just fine; for others they will want a more integrated solution.
Now let’s talk about technology as it relates to scheduling and billing.
Ideally appointments should be confirmed in writing to minimize the risk of no-shows, and to avoid the “I had no idea I had an appointment you’re not going to charge me are you?” conversation after a patient no-shows. Appointment reminders are also a nice courtesy, and are commonly used in medical practices. Confirmations, reminders, and cancellation notices should all be generated automatically if possible.
If you can offer online booking, that makes everything even easier. You do have to relinquish some control over your schedule, but it will free up a lot of time for you to focus on tasks other than scheduling, or using session time for scheduling. You’ll have to find a good balance if you offer online booking, in terms of which slots you offer. For example, you don’t want to be in the grocery store at 4 p.m., and get notified that your 4:15 p.m. slot just filled. You also don’t want to offer a slot 6 months out, then have to cancel it because you didn’t realize you’d be on vacation then. On the flip side, the longer the span you can offer for booking, both near-term and long-term, the more slots you’ll be able to fill.
Once you do see the patient, it’s nice to be able to bill for the appointment right away, so that your work to-do list doesn’t build up, and patients don’t get surprised down the road with an invoice. If you can find a system where you can link your notes, scheduling and billing all together, that’s a time-saver.
On to practice finances – are you going to use QuickBooks, or a software like that, on your computer? Or are you going to use an online system? If you are, it of course has to be hipaa-compliant. What about hiring a biller? That would make things easier, but they’re expensive. How about recording your expenses for the practice? At the end of the year how are you going to do your taxes? The more you have this all in software or securely online, the less time and stress you’ll have to burn at the end of each month and year.
No technology conversation would be complete without talking about safeguarding that technology. The main federal legislation that governs all of this is covered under HIPAA, but state laws can even be more stringent in some cases. Both are attempting to ensure that protected health information is indeed protected, and if that process breaks, there can be fines, public shaming, and possible repercussions to your license.
HIPAA isn’t just about having a password on your computer. All practices must have a risk assessment plan that documents administrative, technical, and physical safeguards to protecting patient data. One of those measures is a business associate agreement, or BAA, and you are required to get these in writing, co-signed with any company that offers to work with protected information. If a company won’t sign one for you, don’t do business with them.
Of course there are some other measures that you can take to reduce your risk. For starters make sure your hard drive is encrypted, not just password protected. Never use public Wi-Fi. Never use regular email, or a cloud calendar, or a cloud-based billing solution, like QuickBooks Online, without a signed business associate agreement.
So, that wraps up today’s presentation – I’d recommend you think through the pros and cons of technology options as they apply to your unique practice situation. Do free trials so you can test out your assumptions in real-time. And of course, get a business associate agreement in writing with any vendor that handles protected health info.
And, browse more helpful content in our Private Practice Hub resource center for lots of other free, useful tips. Thanks for tuning in and wishing you the best in building and growing your practice.