Take-Charge Software Helps Manage O&P Practices
By Judith Philipps Otto It's no news that these are tough times for O&P
practices, and if there's a lifeline available to assist you in
improving efficiency, developing documentation, increasing security
compliance, and reducing paper clutter, it's only sensible to seize
it gratefully.
Computers are handling more chores in more practices than ever
before - even clinical applications - but they are still not being
utilized as fully as they could be. Part of the reason is, of
course, the investment cost - in dollars and in employee hours
spent learning arcane new systems.
Since often it is a simple case of not knowing what you're
missing, we have undertaken the task of cataloging the capabilities
and identifying the sources that can provide them for you. So if
you're wondering how new or expanded computer software systems can
help you, let us count the ways - and name them, too.
NOTE: Identifying common and/or parallel
features among the various systems we researched is virtually
impossible, making comparisons not only politically hazardous, but
inappropriate. It's not so much like comparing apples and oranges
as comparing footballs and baseballs; each does its assigned task
effectively, and it is strictly user preference which determines
the design of the vehicle chosen.
Futura OPS Software
 With the current emphasis on HIPAA compliance for
electronic information, every data field of information within an
office management software application must be secured. Therefore,
control of ePHI (electronically protected health information) is a
key feature of Futura's package.
This control extends not only to how the information comes out
of the computer or who has access to it after it hits paper, but
also to how it's controlled within the system. Futura's security
features carefully control who can view the information and who can
edit it.
"In our circumstance, security control is part of the management
software developer's responsibility," said Terry Long, president of
Futura International Inc., who takes this responsibility seriously.
"In addition, we are not aware of any other software company that
currently provides PHI field-level control."
That control includes role base security levels (for example,
supervisor, clerk, receptionist, practitioner), which Long
considers a critically important feature of the Futura system;
instead of just setting up security levels saying whether you can
sign in or access the application, the software ties security
limits to every aspect of the application, protecting each one to
the level specified (for example, field and record levels).
From a clinical perspective, Futura also provides a completely
paperless solution. All documentation needs for clinical assessment
are, or can be, totally automated. Any aspect for billing or
clinical collection of information is done digitally within the
system. This includes, but is not limited to, measurement forms,
automated progress notes, electronic SOAP notes, clinical outcomes
assessment, as well as storage of electronic signatures, digital
images, scanning, etc.
Futura's system is designed to be deployed within the
purchaser's environment. However, Futura also provides an
affordable ASP (applications service provider) service. By having
Futura host the software, clients are saved the purchase cost of
the hardware needed to function at their site, including IT
support.
Long pointed out that using Futura's ASP service protects
clients even better with regard to HIPAA compliance and security
provisions. "It actually puts them in a more protected arena
because it's off-site and there is no data available in their
facility or in their computers."
Another advantage of the Futura application is its wireless
support capability. Since clinicians and practitioners are using
more wireless devices (for example, PDAs and PC Tablets), the
Futura application enables the clinician or practitioner to remain
mobile in a wireless environment. Since no data resides on these
devices while they are out seeing patients, there is no security
crisis if the device is lost or left behind, Long pointed out.
"They can connect via cellular technology to our server and receive
real-time information for appointments, clinical documentation,
visual images, without carrying any charts."
Recently, Futura released its QuickBooks integration. "Since
many facilities use QuickBooks as their accounts payable and
P&L application, Futura now enables integration in order to
eliminate separate maintenance of the two applications," said
Long.
Coming Soon:
- Later this year, expect Futura to integrate its software with
the inventory and product information of manufacturers such as Otto
Bock. "We are combining their product catalog into our inventory,
as we will soon be doing with all the manufacturers," said Long.
"All the products will be built into each client's application, so
they don't lose time sitting on the Internet or pulling
catalogs."
- Futura will also be instituting a user group forum on its
website. This will allow users to interact with OPS professionals
and post focused questions or actively help others with tips and
ideas for practice management.
MedEvolve
 Statistics are valueless unless you can
(a) access them and (b) analyze
them. While many practices already receive reports of business
activity, receivables, etc., finding specific data for analysis
often means manually sifting through a series of printed
reports.
Jay Davison, president and chief operating officer for MedEvolve
Inc., feels that one of MedEvolve's software's primary strengths is
its ability to analyze data. "While some systems have report
writers on which you can construct a report, they're a bit
technical and difficult to work with, and consequently they are not
used. MedEvolve's software is quite intuitive. If you need to
determine how many diabetic BK patients have received care within
the last year, our Microsoft Windows software is equipped to do
that. Most of our modules use MS products, so we're not reinventing
the wheel; we can pick up and use them as tools to analyze data for
the practice."
Some other software creators build their own systems, but
Davison noted that such adapted systems can be difficult and
frustrating to work with. "You spend so much time trying to work
with the report writer that you're not spending much time
experimenting with the findings. Some of the best research begins
with a vague question that raises further questions, which leads
you to continuing analysis - drilling down through the data is what
we call it. Our tool facilitates that process very nicely for a
nontechnical individual."
Another advantage of the MedEvolve software is its ability to
tie into the revenue stream by streamlining the insurance claim
process. Instead of sending claims to a clearing house - which
distributes them among the various health plans and usually charges
a transaction fee for its trouble - the software allows users to
send standardized, HIPAA-compliant claims directly from their
system to the insurance entity - for example, Blue Cross.
Not only does this expedite the process and eliminate
transaction fees, but it limits the number of hands (and eyes) the
claims are exposed to, thereby improving security and reducing the
opportunities for error.
"Claims are much quicker and cleaner," noted Davison, "and if
there is an error, it's much quicker to locate its source."
Davison expressed the MedEvolve philosophy behind such business
decisions, "We want to be known as the software provider with the
major profit impact on our client's practice. Even in terms of
pricing product, we'll give up a short-term gain in order to
maintain and enhance that reputation of being committed to our
clients' profitability."
MedEvolve also offers outsourcing, but when Davison offers that
choice, he offers an effective metaphor. "Would you like a fish? Or
would you like us to teach you how to fish?"
Often, however, outsourced customers who were initially
intimidated by the perceived complexities of computer technology
begin to realize it's not so difficult, after all. Using
long-distance training through linked computers to illustrate and
explain, Davison advances them to an in-house system.
"Perhaps 90 percent will initially request the outsourcing,
while probably 60 percent, once they're shown how it works, will
take it back in-house."
Naturally MedEvolve charges a larger fee for outsourcing, but in
the long run, it's better to have clients in-house doing their own
work. "Because then they get creative, and then they get
enthusiastic, and that means they are a more powerful word-of-mouth
reference for us."
MedEvolve's exclusive Document Manager serves as an electronic
patient chart, allowing images, X-rays, EKGs, letters and reports,
to all be filed electronically in the patient file. Each item,
however, is granted individual security by a system that supports
that HIPAA "need-to-know" philosophy.
The electronic medical record (EMR) can be widely general or
carefully specific. MedEvolve partners with a variety of EMR firms,
allowing software users to use an EMR form specific to the needs -
for example, O&P. The EMRs can be complex, including
security-based medical pathways, but MedEvolve's core design
criteria in building the system is to maintain that secure
electronic record and be able to pass it around easily, Davidson
said.
Rather than market separate offerings, "We do have some optional
modules, but we tried to package the core applications almost
everybody needs," Davidson said. "We're not really designed to
serve a very specialized practice that already uses a billing
service and only wants a document manager. We're geared for
practices that are trying to take care of their entire set of
business in-house with their own staffs."
MedFlex
 Specialization is the key to efficiency when it
comes to software. Generalized or "horizontal" applications that
work for many different businesses have limited value to a
specialized business. MedFlex was developed by custom programmers
as the response to a need for a specialized or "vertical" software
system specifically for O&P.
Since its original development for its first client, Becker
Orthopedic, nearly two decades ago, MedFlex has naturally evolved
with the times and in the direction of greatest demand, using
rapidly developing technology as soon as it is available.
"When we first started," explained John Mason, president of
MedFlex, "computers weren't capable of storing a gait analysis
video, and the hard drives were much smaller. At that time, a
$5,000 hard drive held 340 megabytes; now, $80 buys a one-gig card
for a digital camera." And since software capability is contingent
on the existence and affordability of hardware to support it,
MedFlex is perpetually adapting new solutions and systems.
Mason points out that clinical software applications are
relatively new, because previously no appropriate hardware existed
to handle them.
As a system grounded in systems design and database experience,
MedFlex's foundation has previously emphasized its strengths: for
example, integration of all business functions, including
HIPAA-compliant billing.
How important is it to offer both administrative and clinical
aspects in a software system for an O&P practice?
Critical, Mason believes. "Otherwise you have people duplicating
information indiscriminately.
"The reason a number of people pick our software is not only
because it has the clinical information and the business side
covered, including electronic submission, but we also have
inventory, purchasing, general ledger, wip, and payables. We're the
only one in the medical field that has all of that. With other
systems, people run accounting systems that are separate from their
billing system. From a small business owner's perspective, this
lack of integration creates a weak point of control. Most people
have a mess, and they don't know where they stand until the
accountant tells them a couple of months after the fact."
MedFlex affords its users strong point of control, so people can
reconcile to their bank every day if they want, via phone or
Internet, Mason said. "In our world, the owners can touch a button
and know what their profit-loss was that week, compared to any
other week in their history."
From a clinical perspective, maintaining patient records can
become complex if the user's software only allows for one set of
demographics per patient, as is the case in systems that are
billing-focused. If no allowance is made for multiple registrations
in the database, what happens to the patient who is first a
hospital-treated accident victim (with the hospital as guarantor),
then is referred to your practice by his therapist (as his own
guarantor)? Two - or more - separate records for the same patient?
If so, how do you locate clinical information stored under multiple
patient numbers?
MedFlex allows multiple layers and multiple registrations under
the same patient number, maintaining the integrity of the patient
record and eliminating problems and confusion. The marriage of
clinical and billing information in this manner provides a
comprehensive picture for later reference, and constitutes vital
documentation.
Another unique MedFlex feature is fee-analysis summary. Scanning
a year's worth of data may produce a report 6,000 pages long. By
previewing CPT rankings, however, users can determine what's
driving their business, seeing the percentage of sales for specific
L-Codes, and selecting the few pages that are important enough to
print. For most O&P businesses half the business is documented
on the first page of this report. Also covered in the analysis is
the success rate for claims submissions, including the number of
times Medicare non-assigned claims were submitted, contract amount,
and disallowed; and also current Medicare amount received,
including patient portion.
This produces a bottom-line percentage that identifies how far
over or under Medicare allowables reimbursement has been, and helps
create a clearer picture of what is making or breaking the
business.
MedFlex's open-box format for clinical information also allows
users to add to the system any tools they have already developed or
used in-house, in addition to pre-programmed choices. These can
include CAD, spreadsheets, voice files from PDAs, PDF files,
electronic forms, or any Windows-registered application.
Storing and backing up all these large files isn't a problem,
claims Mason, due to Medflex's method of burning historical data
into optical storage via date selection, along with a utility that
allows the user to move information to an external hard drive and
add unlimited stacks of hard drives which are still readily
accessible.
Among multiple other analysis potentials offered by the system,
performance by practitioners can be tracked. MedFlex assigns
practitioners to jobs, rather than to patients, since patients are
often seen by different practitioners on different occasions.
Patient satisfaction surveys and follow-up reports are also
well-covered; even thank-you letters can be automatically generated
to referring physicians as well as physical therapists or any other
relevant marketing source.
"And since we wrote our scheduler from the ground up, it also
contains unique features and is highly integrated with our
software, not an afterthought," Mason said. The scheduler starts
and tracks the jobs, generates the charge tickets, manages clinic
assignments, and interfaces with the collections job to message or
prevent patients being scheduled that have ignored collections
issues.
Parts and supply ordering systems also boast special features,
and for businesses with multiple locations, the MedFlex system
seamlessly integrates all locations within the same data set,
including controls and security appropriate to separate sites,
Mason noted.
MedFlex builds systems and assists clients to connect with an
appropriate server, but does not offer hosting service. Most of
Medflex's clients run the software over the Internet with 128-bit
encryption, because they have multiple offices. "If we handled
central hosting and we lost our Internet connection, then we'd have
600 O&P offices around the country go down," Mason pointed out,
not a risk the company is willing to take on behalf of clients.
Using "thin client" software, MedFlex customers can, however,
receive online-linked educational support in real time via any PC
with an Internet connection. The standard "thin client" from
Microsoft is 128-bit encryption out of the box, Mason explains.
Coming Soon:
"Because many of our clients have been clients since the 80s,
our system evolved on what is called a peer-topeer database. We are
moving toward a free SQL-based system with worldwide support, so
our small clients won't have to pay the big bucks to migrate to
this more flexible database platform. Once we're in that platform,
that will allow people to do more things with their software
utilizing more levels of integration in the future; it would allow
us to come up with, perhaps, an appointment-request web page for
patients who can interact right with the main database, and a
method of e-mailing an appointment confirmation to the patient.
"I think that level of integration in using wireless Internet
will continue, and more capabilities will come because of that. We
can already do some of that now."
Mason notes with pride the success of many of the company's
clients as they have grown and added offices and become dominant in
their geographic O&P market. He hints that Medflex's
involvement at the ground-floor level on a new and growing venture
will be making news soon.
OPIE
 OPIE (Orthotic & Prosthetic Information
Expert) holds the distinction of being created from the perspective
of an O&P practitioner and business owner. As one of the newest
kids on the block, OPIE's development began in 1999 when Paul E.
Prusakowski, CPO, FAAOP, president of oandp.com, decided to create
a digital system to monitor and manage paperwork related to the
patient care process.
This first step was taken with a larger goal in mind: to create
a system that completely integrated all aspects of the clinical
practice management process - increasing efficiency, reducing the
margin of error, enhancing communication, automating processes, and
providing complete documentation throughout the entire process.
"To create a comprehensive, integrated system," said
Prusakowski, "we needed to recognize and address the unique roles
of various individuals within the practice. Thoroughly
understanding workflow needs in the dynamic environment of an
O&P practice was essential. While individual software tools
were already promoting efficiency, we knew that the most
substantial time savings would be realized when the entire process
was tied together seamlessly to allow the practitioner to manage
all aspects of patient care with as little friction as
possible."
The result of their efforts is the OPIE Practice Management
Suite - an integrated collection of software tools developed for
practitioners and technicians as well as for clerical and billing
personnel, helping them to automate and organize the entire
practice.
Although Prusakowski noted that the billing and collections
module is not yet available, when it is released later this year,
the full suite of tools will handle electronic medical records,
fabrication management, purchasing management, scheduling,
documentation, electronic billing and collections.
"OPIE is considerably more than billing software with a few
added features," said Prusakowski. "We've approached it from a
completely different direction, and the result is that everyone in
the practice uses and benefits from the OPIE Suite. This also means
that the business owner has a better view of what is happening in
his/her practice, because it is all tracked in one integrated
system that provides detailed reports."
Prusakowski also noted that OPIE integrates with the
Internet-based tools that oandp.com has developed, including
different technologies designed to help a practice and a
practitioner run more efficiently.
"I think what truly differentiates us is the combination of a
practitioner-centric approach and an expert software development
team that knows the industry," he added. "This was my baby, not a
billing software company's invention, and we sought input from
leading O&P professionals to ensure that the software would
meet their needs. Our team has been developing Internet-based tools
for this profession for nearly ten years, so the extension into
O&P practice management software was natural for us."
With the new billing and collections module still in the beta
testing phase, an OPIE Suite client would of necessity be running
some parallel systems until that module is available on the market.
The current software provides an operating system for running the
entire practice, minimizes administrative overhead by feeding the
billing persons the information needed to enter into their billing
software, and simultaneously creates complete documentation of
events on the clinical side.
OPIE is also developing interfaces that will allow its clinical
management software to work with some billing software systems,
offering clients greater flexibility.
Purchasers of an OPIE Suite set up their computer network with a
local specialist, and the initial software installation and
training are done remotely, although OPIE does offer "for-hire"
onsite visitations, if requested.
Including users of the OPIE Lite version, a free-standing
purchasing management piece, Prusakowski estimated that about 40
companies are OPIE clients, representing close to 70 office
locations. Once the eagerly awaited billing and collections module
is complete, he anticipates doubling that figure within 18
months.
"The complete OPIE Practice Management Suite will integrate all
aspects of the clinical practice, providing software tools for
everyone in the office, giving the owner/manager/ practitioner
complete control of all information, significantly reducing paper
and streamlining processes, and raising accountability for
everybody involved," said Prusakowski.
Coming Soon:
OPIE is integrating with a growing list of companies to provide
electronic catalogs and direct electronic ordering from within the
software. Companies already on board include Ohio Willow Wood,
College Park Industries, Kingsley Manufacturing, Prosthetic
Research Specialists, and O&P1, with more on the
way, Prusakowski said. This next level of integration between
provider and supplier offers welcome benefits to both.
For more information on the companies mentioned in this
article, visit:
Futura International Inc.,
22051 U.S. Hwy 19 N., Clearwater, Florida 33765; phone:
727.791.3332; fax: 727.726.7164; e-mail: sales@futuraintl.com; www.futuraintl.com
MedEvolve Inc., 17300 Chenal Parkway, Suite
301, Little Rock, Arkansas 72223; phone: 800.964.5129
ext. 301; e-mail: jay.davison@medevolve.com; www.medevolve.com
MedFlex, 314 Buckingham Dr., Lafayette,
Indiana, 47909; phone: 800.728.7936; fax: 765.471.9961;
e-mail: johnmason@MedFlex.com; www.medflex.com
OPIE, 6830 NW 11th Place, Suite 1,
Gainesville, Florida 32605; phone: 800.876.7740; fax:
352.332.0161; e-mail: opie@oandp.com; www.oandp.com/opie
Companies mentioned in this article are included for reader
information only. This is not a complete list of
companies producing medical and allied health practice
management software. The O&P EDGE does not endorse any
specific companies, products, or services.
Judith Philipps Otto is a freelance writer who has also
assisted with marketing and public relations for various
O&P industry clients. She has been a newspaper writer
and editor and has won national and international awards as a
broadcast writer-producer. 
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