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Is Your Pediatric Practice Software Integrated Across Multiple Functions of Your Pediatric Group?
Ken Dominy
A pediatric practice has many tasks that occur throughout the practice. These tasks are different functions and areas that are critical to a successful practice. Functions that occur in a pediatric practice include: checking in patients, entering patient and insurance demographics, verifying insurance eligibility, verifying co-pays and patient account balances, recording copays, scheduling patients, linking patient by family, taking vital signs, verifying and recording vaccinations, having clinical templates based on bright futures well visit recommendations, sending electronic prescriptions, management of scanned documents and referrals, sending and receiving labs from Quest and Labcorp, maintaining insurance information, and managing claims data and payment data for CPT codes, ICD10 codes, and HCPCS codes.
A pediatric practice software platform should have reporting to help identify performance opportunities and issues across the pediatric practice. Software is a tool to develop and connect various functions. A software developer or engineer works to build software to meet a specific function. Developing software for a pediatric practice is a balance between how easy to use and how much function to provide. Additionally, the developer needs to consider maintenance of the software. The simpler the design the better, with the thought process that the software should help automate many tasks.
Good software design usually requires less training due to the design of the system. Most EHR software have complicated interfaces that require much training to use effectively. Ideally, the software should be one platform that is integrated from end to end. Integrations between systems are important and take time to execute. Sometimes other systems are on different standards. For instance, the immunization exchanges in the country have different requirements, and adjustments are needed with each state. This can either be accomplished by the software vendor or a company that works with software vendors and is connected to all the states.
When designing integrated software for a pediatric group, the designer needs to consider the core and support functions at the practice. The core functions that generate the revenue for a pediatric group are; Front Desk, Medical Assistant/Nurse, and Pediatric Provider (Physician, NP, PA). The revenue management part of the group is a practice admin with outsourced billing team or practice manager with a billing manager and billing team. Let’s look at the core revenue generating roles in more detail from the perspective of integrated pediatric practice software:
Front Desk:
The front desk team members should be able to log into their own account, verify patient information and enter new patients in, enter insurance information and check insurance eligibility, record referrals, record co-pays and patient amount due, send tasks to other staff members, verify VFC eligibility status, and send secure emails to other practice team members. The software should perform all these roles in a simple to learn/understand manner.
Medical Assistants/Nurses:
Medical assistants and nurses start the clinical care process for the patient. The software needs to support their ability to take vital signs, manage vaccine inventory, manage patient vaccine records and give vaccinations, record procedure results including visual and hearing tests. The data from these tasks needs to be integrated across the electronic record.
Pediatric Providers:
(Physicians, Nurse Practitioners, Physician Assistants): The pediatric providers utilize the information contained in the patient record for diagnosis and treatment. The software should contain tools such as clinical templates based on age (e.g. bright futures aged base templates) as well as sick templates. Additionally, the providers should be able to use this software and request changes. Some software vendors require the practices to make their own changes while others will make the changes for the practice (assuming all the providers are in agreement to the changes). There is a balance of how much to include, too busy and too much information can be a barrier to completing charts effectively.
The revenue management functions of a pediatric practice software should be integrated into the platform. The functions included in revenue management are claim review, sending claim files to the insurance company, and management of denied claims or codes. There should be a dashboard and other tools for real time performance management of the billing claims by the revenue cycle management team. The integration of the schedule, patient demographics, and charts can help the revenue cycle management team be more effective in their role.
Software designed for pediatric practices should be more streamlined than software designed for multiple medical specialties to allow the core team members to perform optimally in their roles. Ideally, a pediatric practice should leverage software that integrates the primary revenue generating roles as well as the revenue management.
