Physiatry Practice Management Resources

While it's no small task simply to keep your practice on secure financial footing, you also need to keep ahead of multiple challenges facing the medical profession. Fortunately, new and established methods exist that can improve your efficiency, clinical performance and compliance with federal rules.

In the past two columns, we've discussed how to place your practice on secure financial footing. Once your systems are in place to bring in revenue in order, it's time to examine and prepare for the challenges that are changing the business environment in which your practice operates. Keep in mind that your practice's financial well being depends on staying abreast of the best ways to serve your patients.

Physicians can continuously improve the operations of their practices by taking advantage new and established methods that can improve their efficiency, clinical performance and compliance with federal rules. Consider using, when appropriate, e-mail communication; upgrading to a secure messaging systems, adapting electronic medical records systems; hiring nurse practitioners to share some clinical responsibilities; and preparing for the upcoming implementation of federal rules to protect the privacy of patients' health information.

E-mail Efficiency
Pay attention to developments that can increase efficiency. The widespread availability of e-mail and Internet access has allowed doctors to streamline communication with their patients. However, currently only about one in 10 physicians have taken advantage of these tools.
According to numerous surveys conducted on this subject, the reason for the slow spread of e-mail communication is fear of malpractice suits. But how real is this fear? Many experts believe that e-mails present no more liability risk than faxes or phone calls. While the security of e-mail is a concern, misdirected e-mail is no more likely to occur than inappropriate follow-up of messages delivered on an automated phone answering system, misdirected delivery of faxes, and the like.

As with any kind of communication system, use of e-mail should be tempered with common sense. Just as test results for serious illness like cancer or AIDS should not be relayed by fax or left on a telephone answering machine, e-mail should not be used to convey these kinds of messages. On the other hand, general advice about taking medication is suitable for e-mail communication.

Certainly, e-mail should not be used in place of seeing a patient in person. Diagnosing or prescribing via e-mail is also unwise under most circumstances. Since a history of the e-mails you may send to a patient can be easily documented, make sure that the advice you give the patients is precise and accurate. For your protection, print out and save all e-mails sent to patients or keep back-up copies and an electronic history of them in a safe location.

In most cases, e-mail security is not broken by the interception of messages but, instead, by third parties that own the computer (and e-mail messaging systems) to which the e-mail is sent. To preserve your patient's confidentiality, keep in mind that employers are legally entitled to read all e-mails received by their employees and that other family members may be able to inspect e-mails that come into a home computer. The bottom line: have your patients sign a release form that frees you from liability in case an unauthorized person gains access to a patients' e-mail system.

Secure Messaging Systems
Another method for ensuring secure e-mail is to encrypt your communications with a secure messaging system. Encryption will soon be required under the regulations promulgated by the Health Insurance Portability and Accountability Act, or HIPAA. The final security regulations, originally proposed in August 1998, are not expected to be released until the end of 2002 and enforced until 2003.
Encryption software is now available on the Internet. To ensure that secure messaging systems covers incoming and outgoing e-mails your patients will have to download the same encryption software. (This measure should cost you less than $200 and can be downloaded for free by your patients.)

Systems are also available that do not require patients to download software. For example, your practice can leave messages for patients on secure Web sites where your patients can gain access to them through a password you provide. Since these messages stay on the secure website, the likelihood of them being read by unauthorized parties is greatly reduced.

Electronic Medical Records
As we move further into the information age, medical practices will increasingly adapt to electronic medical records (EMRs). The advantages of EMRs include their accessibility from several different locations simultaneously, elimination or reduction of mistakes due to illegible handwriting in the medical record or prescription orders, the security they offer to patients, and their ability to create templates for additional and retrieval of clinically valuable information.