In 2004, Lynn Ho, MD, decided she wanted to change the way she practiced medicine and opened a solo family practice in North Kingstown, R.I. She was frustrated with the thought of big practices “swallowing up small ones” and wanted to ensure her individual practice would be stable long-term. She turned to technology to improve patient access, make her practice run more efficiently, and deal with documentation requirements.
“People are so busy and overbooked and can’t handle one more thing,” Dr. Ho said. “But I always say, ‘Go forth and do,’ because these things really work. The world is moving on; people are using their smart phones for everything.”
In her view, technology should not be daunting for small practices. Larger groups often deal with inertia that keeps them from making decisions, but smaller practices can easily implement some of the solutions Dr. Ho has found helpful. Here is a look at what makes her practice tick.
One of Dr. Ho’s favorite tools is a product that allows patients to fill out their medical history electronically prior to their office visit. She uses Instant Medical History for chronic care, acute visits and checkups. She began using the product in 2006 and has had to train her patients how to use it, but a majority now uses it regularly. Patients are able to give a family, social, and past medical history before their meeting. Dr. Ho then looks it over, pulls out pertinent information, and writes in short hand what is important for the visit. Patients can fill the information out from home or, alternatively, at the office from an iPad she has in her waiting room. The system “saves me a pile of time so I can get right down to business.”
On its website, Instant Medical History offers an estimate of potential savings per physician who uses this technology. According to the company, having patients fill out their own history saves about 4 minutes per patient. If a physician sees 25 patients a day, this would save 100 minutes, or 6 (15-minute) appointments, which equates to about 100 visits per month. Multiplied by the cost per visit, this could net real savings in a small office.
Dr. Ho works with an inexpensive, simple patient scheduling app that any physician can use to book appointments. She estimates a time savings of 1 to 2 hours per day by using www.appointmentquest.com. The program, which costs her about $18 a month, is “remarkably sturdy and easy to use.” There are a handful of other programs out there that offer this service, so it won’t be challenging to find a vendor.
Using online appointment booking reduces the time patients take to make an appointment, but also the time spent on the phone during practice hours. Physicians who are not offering this service may be missing a simple way to grow their business. According to Google research, almost half of all patients who used a mobile device to research a hospital scheduled an appointment. Online booking would only facilitate this process.
Dr. Ho sometimes communicates with patients by e-mail, and while this is time for which she is not reimbursed, e-mail provides a more efficient means of communication than the telephone.
“If you are looking at it in short-term fashion to see if you are getting paid for e-mails, you won’t, but in the long view it gives good patient access,” she said. “This asynchronous communication is totally great for patients.”
Dr. Ho uses e-mail provided in her patient portal for “a million things.” All patients get an e-mail back with lab results, but she also uses it for follow-up after labs, to increase doses of medication or refills, and so patients can send her notes asking things like whether or not they should come in for a visit.
“Through e-mail, people really feel like they can access your medical knowledge,” she said.
Dr. Ho performs about 50 e-visits each year for which patients self-pay $25. She said she uses these for simple issues, and they work great for many patients, particularly on holidays or other times her office is closed. Individuals can go to her site, click on e-visit and are directed to PayPal for payment. After payment, they are directed to a medical history tool where they supply information on their problem. She receives a text telling her that someone has been to the site for a visit. She tries to give them a diagnosis, recommendation, or other treatment information within about 4 hours.
There are a handful of other technologies Dr. Ho uses to make her practice more efficient, including:
- TextExpander for documentation. This program corrects typos, automatically fills in forms, and uses abbreviations for commonly used terms.
- Boomerang for Gmail, which mail allows her to create an e-mail message and send it out at a specific time. For instance, if she wants to have someone come in for a follow-up visit, she creates the e-mail right away and Boomerang sends it to the patient a month later when he or she needs to make an appointment.
- Sookasa, a product for file sharing that is compliant with the Health Insurance Portability and Accountability Act.
- EClaims, which works as an electronic billing clearinghouse. It scrubs claims, fixes rejections, and provides proof of submission.
- How’s Your Health, a tool that Dr. Ho requests patients fill out annually that provides key practice metrics from the viewpoint of patients. Questions on the site include information on access, efficiency and coordination of care.
To summarize, she said she uses technology because “it’s cheap and it works.” Do not be afraid to try different programs or products. If they don’t work, get rid of them, she said. This technology is becoming increasingly inexpensive, making it more affordable to try.