Few physicians would contemplate running an office without some type of practice management support-the software and systems that organize the immense amount of data that flows through their clinical and administrative operations.

But physicians are notoriously cautious about investing in technology to manage billing, collections, scheduling and patient records. And the whole movement toward electronic medical records (EMR) has some weighing their options even more closely.

In other words, practice management software decisions are some of the most practice-personal decisions you will make. Here are six issues to think about.

1. Don't switch for the heck of it.
It's not wise to upgrade systems just for the sake of switching. Unless there's a problem you're fixing or advancement you're seeking with new technology, you can make things worse by changing a process that's not broken.

Robert Duncanson, MD, a Riverside pediatrician, reports that his practice adopted a program called Medical Manager more than a decade ago--after using its previous system, called CyCare, for about 10 years prior to that.

The reason Dr. Duncanson is sticking with Medical Manager is one that many practices can appreciate. "The switch was so painful that we hope never to have to repeat the experience, as long as the system continues to do what we need most: scheduling and billing, both paper and electronic."

So far, Dr. Duncanson adds, that's the case. "We're actually still quite satisfied with our old system," he says. "It does everything we need it to do, quite efficiently, with rare down times."

The system costs about $6,500 for software maintenance annually, and the practice contracts for hardware maintenance as needed, Dr. Duncanson says.

2. Evaluate your personal career stage.
Retiring soon? Not crazy about technology in the first place? Maybe practice management software upgrades can wait.

"Our IPA is strongly encouraging us to work toward implementing a fully electronic medical record," Dr. Duncanson says, "but the upfront cost and time commitment is staggering. It will probably become a reality with our group within the next five years, but I'm only a few weeks away from retirement--so my motivational energy is focused elsewhere."

Integrating existing practice management software with EMR software is a whole new game. "If I were going to practice another 10 to 12 years," Dr. Duncanson says, "I'd be seriously looking at upgrading."
 
3. Check your state of mind.
Justin Graham, MD, MS, medical director for quality and informatics at San Francisco-based Lumetra, Medicare's Quality Improvement Organization for California, emphasizes that asking yourself critical questions is as important as asking software vendors questions about their products.

You need to ponder your readiness for change, staff readiness for change, the existence of appropriate leadership, the existence of necessary policies and procedures, whether you have support from top leadership, and the absence of competing priorities.

Lumetra's free DOQ-IT (Doctor's Office Quality--Information Technology) program helps physicians choose and implement EMR systems. Go to www.lumetra.com and click on DOQ-IT for additional details on the process, Dr. Graham says.

4. Take your time.
Dr. Graham notes that just selecting a vendor can take as long as six to 12 months--or more. For example, William E. Callahan Jr., MD, a psychiatrist in Irvine, put a couple years into looking for the right system, focusing his efforts mainly at conventions and trade shows, where there are many vendors and it's easier to compare and contrast products in person and in one place.

After you buy, the implementation phase can last up to six months--and that's when things can get difficult. It can involve redesigning work processes, retraining staffers and rerouting the flow of information.

"There can be a lot of anxiety and angst and chaos," Dr. Graham says. "It can take months or years after implementing medical records software for a practice to return to pre-implementation productivity levels, although some well-organized practices have demonstrated impressive productivity improvements in a much shorter time."

5. Consider EMR technology standards.
If you decide to take the EMR path now, the terrain will likely be rocky, as vendors and others try to work out the details of system interoperability.

"The benefits of EMR software for retrieval of labs and prescriptions all in one place are enormous," Dr. Callahan says. "Of equal or greater importance is making sure appropriate firewalls and backup drives are in separate places and, for practices with employees, that no one takes a drive home--like the Department of Veterans Affairs employee who released via a theft millions of bits of highly personal medical data. That's the great malpractice liability we face in going down [the EMR] path before there are national standards. ... I opted for something not too costly and made sure I had addressed the increased potential risks."

6. Keep your system simple, if possible.
Dr. Callahan's system was developed by a psychiatrist in New Jersey. It cost just $450 or so--not the "outrageous" investment required for some systems, he says.

"Very importantly," Dr. Callahan says, "it is built on Excel software, so I'm not stuck with something proprietary and forced to use that company for maintenance. Also, the system I have will be upgraded as Microsoft upgrades Excel. Also, if the company I got it from goes out of business, there are likely to be many programmers who know Excel who can help."

Again, the message is that technology is personal--and as the practicing physician, you're the person who has to think the most about systems. Such decisions are definitely not something you can delegate.