Community Health Center Information Systems Assessment: Issues and Opportunities. Final Report. Practice Management


Practice management  systems generally deal with appointment scheduling, billing and accounting, enrollment and eligibility, coding and claims processing, patient demographics information management, master patient index, and, in some cases, recordkeeping functionality (i.e.: encounter documentation). According to industry sources the vast majority of large to medium sized physician group practices have implemented some form of practice management software to handle basic administrative and office management tasks such as scheduling, billing and resource management. Still, thought leaders indicated that the majority of clinics are running multiple systems for administrative record keeping and that these systems are not meaningfully integrated and are running at less than full efficiency. For example, many clinics combine use of dedicated practice management tools with generic tools such as the MS Office Suite (e.g., Outlook, Word, Access, etc.) to manage and track the wide range of administrative functions central to the operations of a clinic. Very few clinics under 10-15 physicians have dedicated IT staff or a conscious strategic plan to systematically integrate practice management tools into their operations.

Interviewees described a highly fragmented market for practice management software, both in terms of demand from clinics and the landscape of vendors. Customers are gradually developing sharper preferences regarding requirements and service providers are slowly adapting to these preferences and growing smaller through mergers, acquisitions and closings, making it difficult to get an accurate sense of the core differences between providers. Most providers offer the same basic functionalities: patient appointment scheduling, tracking of patient insurance plan status and terms, patient billing/claims submission and financial systems and inbound and outbound referrals. Many products also include advanced features such as capitated billing and financial management and allow for easy exchange of data with managed care and major insurer information systems to facilitate overnight verification of eligibility and automated electronic claims submission and payment.

Because practice management marketing efforts primarily target administrators rather than clinicians the most sophisticated products include tools to help identify and address opportunities to recover lost revenue including electronic submission of all insurance claims, claims editing and tools to facilitate analysis of revenue and claims by payment source and other relevant variables. Another relatively new, advanced functionality is combining resource management (both plan and labor) with scheduling. Finally, looking forward, thought leaders indicated that the major distinguishing feature among practice management vendors is their ability to offer products that easily integrate all administrative, financial and resource management aspects of clinic operations and that effectively sync data from those functions with patient-level electronic medical records or electronic health records. Relatively sophisticated vendors that currently offer combined practice management and electronic health record products include Medic computer systems and Mysis LTD of the UK.

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