Setting Up Technology in Your Private Practice

In the fourth episode of Practice Matters, Payal Kohli, MD, founder of Cherry Creek Heart in Denver, discusses what hardware and software you need to get your practice up and running. Kohli is also the medical expert for 9News/Daily Blast Live.

The following is a transcript of her remarks:

Today's episode of Practice Matters is one of my favorites. We're going to talk about the importance of technology in setting up and running your private practice. So, let's get started.

I would say the way to think about technology in your practice is to divide it up into what you need for your clinical practice, and then what you need for the administrative part of your practice.

Clinically, I would say the most important piece of technology you're going to have is a really solid cloud-based electronic medical record [EMR] system. You want to make sure to get one that has billing functionality as well, so that you can do a lot of the claims processing and the clearinghouse work that's needed to drop your claims to the insurance companies.

Now, how to pick one is a topic for another episode, but your cloud-based EMR will really guide you on what type of antivirus software you need, what types of security measures you need to have in place to ensure HIPAA protection, and all of the hardware that you might need on your computers. But thankfully, most of the contemporary cloud-based EMRs just need a regular laptop or a regular desktop. You don't need anything really fancy to run it.

Now, if you're going to have imaging as part of your practice, like I do as a cardiologist, you're also going to want a really solid cloud-based PACS [picture archive and communication system] reading system or DICOM [digital imaging and communications in medicine] reading system, so that you can actually access your images, read them, and write reports from anywhere. That, you'll see, turns out to be a lifesaver if you're sitting on vacation on the beach somewhere and you need to look at an echo [echocardiogram] or you're behind on reading your echoes or what have you, that you can access it from anywhere. So that's the clinical piece.

Administratively, I would say a few things to keep in mind. The first is to have a really solid bookkeeping software that also allows you to do payroll. This keeps your costs down in the beginning, and also really allows you to have a sense of how much you're spending, how much you're making, because that bookkeeping software, something like QuickBooks, which is also cloud-based, can really help you track that.

The second thing you need for administratively running your practice is a VoIP, or voiceover internet protocol telephone. This is basically a phone that works through the internet. The advantage of this kind of technology is that you can have virtual assistants all over the world. I, for example, have a virtual assistant who works out of the Philippines. He answers my phone, he's a front desk person. That helps me to keep the cost down. It also allows me to be able to have multiple people manning the phones at the same time, because this allows multiple users that occur.

Now, some fun functionalities that you can add to your VoIP phone is a functionality called straight-to-voicemail. This is a lifesaver when you're calling patients back with results and you don't necessarily want them to answer the phone, you just want to leave a quick message about something. You can actually call them in a way that sends it directly to their voicemail. And, of course, texting is also a nice thing to have.

Finally, the website has to be solid. You don't necessarily need to have a fancy one, you can design one yourself, but you do need to make sure that it's maintained and kept up-to-date so that patients can access your contact information, your fax number, and also reach out to you.

My last piece of advice would be to buy yourself a nice new laptop. It's a treat to yourself, but also make sure it's got a good webcam, because you're going to need that for all those meetings that you have to have with vendors and all the other people as you're setting up your practice.

You know, it's kind of interesting, you have to learn as you go. There's really not a guide for us to go and know exactly what the industry standards are, but really your best bet is to make sure you talk to your EMR vendor. They'll help you get started on what you need.

What I like to say is that you start slow. You're not jumping into every piece of technology that you need right away. I, for example, am constantly adding technology to my practice every single year. So, for example, I started a workflow process where patients can now check in online, they can pay their copay, they can fill out the intake, they can do a lot of those types of things before their appointments. For my tech-savvy patients, this saves a lot of time in the office.

We also started a workflow process where we're using shared notes and apps that can allow you to share tasks across different providers and different staff members. This is a nice way for us to know who's doing what. For example, if a patient needs to be called back or scheduled and there's three or four MAs [medical assistants] in the office, you create the task, share it with them, and they can allocate the work accordingly.

We've also created a workflow where we really allow patients to minimize their portal messages by having a way that they can streamline their communication. So you're not getting a message from them every single day, you're getting one message with all of their questions.

What you'll learn is that the basics are your EMR and your administrative work, but as soon as you get those up and running constantly, every year or every few months you will be iteratively adding more technology to your practice.

Your best bet to figure out what you need would be to visit a practice like the one that you're trying to create or emulate. So as a cardiologist, I often talk to a lot of private practice cardiologists -- which there are not a lot [of] in Colorado, but across the country there are a few -- and really make a list of what it is you need. So, I needed an echo machine, I needed an EKG [electrocardiogram] machine, I needed a solid set of blood pressure cuffs. Obviously, I needed the technology that we just talked about in terms of the EMR and such.

Once you have a list, then you can start figuring out who your vendors are going to be. I spent a lot of time looking at medical suppliers, but also looking at auctions. This is a great way to get furniture and equipment, for example, for your office without spending a ton of money. Because if you buy it brand new, you are probably going to have to pay the cost, the shipping, etc.

But a lot of companies do what's called medical auctions, where hospitals are closing down or clinics are closing down and they're selling exam equipment, EKG equipment, echo equipment at pennies on the dollar. You could really save a lot of money that way. Just be sure you're getting the right types of equipment, because there's not a lot of administrative support that you'll get if you buy something at auction, you'll just get what you get. But that may be a nice way to at least get basic furniture and such for your office.

With the more expensive equipment, you may want to buy a new piece of equipment because those come with built-in warranties and service repairs and all of those types of things. Or you may want to talk to your friends, if anyone is closing down an office like you have, to get something from them secondhand.

How much money you end up spending really depends on how many providers you have and what specialty you're in, but I cannot emphasize enough that you have to be as lean as possible. I'm talking under $10,000 for all of the equipment to get started, because the last thing you want to do is to bite off more than you can chew. The last thing you want to do is to buy all this expensive equipment and then have to start paying on it right away before you've really started getting a nice stream of patients.

So, start small, but think big, and really make sure that you get your practice up and running with the basics for day 1. But as time goes on, that's when you're going to start to add some of the more sophisticated technology.

Also, don't get roped into a lot of these AI [artificial intelligence] companies, a lot of these patient referral companies. A lot of people out there advertise that they'll do your billing, they'll take care of this, they'll take care of that. Really, really be cautious who you sign up with because if you start chipping away at your profits, you give 6% to this person and 7% to this person, you're going to see that you're going to really have trouble making ends meet.

So, start small, think big, but keep layering in that technology over time.

I hope that today's episode has given you a little primer on all the exciting technology that you can put into your practice and how it can make your life easier. This is a really exciting time, figuring out how you can use technology to make your workflows more efficient and what you want your practice to look like.

So, good luck with getting everything set up, and we'll see you in the next episode.

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