Medical practice management system

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The practice management system of a physician's office in the late 1980s ran on large systems like the IBM PS/2. As computing became more ubiquitous, hardware shrank and PMS software improved.
A medical practice management system (also practice management system or PMS) is a software-based information and enterprise management tool for physician offices that offers a set of key features that support an individual or group medical practice's operations. Those key features include — but are not limited to — appointment scheduling, patient registration, procedure posting, insurance billing, patient billing, payment posting, data and file maintenance, and reporting.[1]

History of the PMS

While computing was advancing in the early 1970s, for many physicians with their own practices the hardware and software of the time wasn't adequate. Aside from the sheer expense, common complaints included the hardware was too complicated, noisy, and wasteful while the software had insufficient language compatibility, lacked flexibility, and wasn't user-friendly.[2][3] But by the end of the 1970s computers were shrinking in size and becoming relatively more viable, and software companies were beginning to develop and sell their own practice management systems to physicians.[4][5][6][7] These early systems typically only managed patient demographics and some billing functions, but as the '90s arrived and computing technology became more ubiquitous, PMS functionality expanded while costs went down from thousands to hundreds of dollars.[8][6][9][10][11] Today, the modern PMS is still capable of managing patients and billing, but it also in advanced cases takes on additional functionality, including integrated electronic health record (EHR), e-prescribing, clinical encounter, and patient portal tools.[12]

Technology

The PMS has traditionally been a stand-alone application, installed on computers in the physician office. But like laboratory information management systems, hospital information systems, and other informatics software, trends have shifted to both web-based and cloud-based access to PMS applications.[13][14] Cloud-based PMSs have been around at least since 2011, and they have become more attractive for several reasons, including the ease of letting the vendor maintain and update the technology from their end, the need for less hardware, and the convenience of accessing the system from anywhere.[15]

In some practices, a PMS is often connected to an electronic health record (EHR) system. While some information in these systems may overlap — patient and provider data, for example — in general the EHR system is used to track patients' clinical outcomes, while the PMS is used for administrative and financial matters. The decision to interface the two systems together or acquire an integrated software package is one of the more challenging considerations for modern medical practices.[16][17] In June 2015, customer satisfaction surveyor Black Book found that 86 percent of providers sought to acquire or upgrade to an integrated PMS-EHR, citing the need to ensure "clinical data and revenue cycle management are aligned in order to support improved operational efficiencies and broad initiatives like population health management and quality reporting."[18]

Standards and regulations affecting PMS development and use

A PMS often needs to not only interface with the outside world but also do so in a secure way. There are a number of standards and regulations that affect how a PMS is designed and used[19]:

  • ANSI X12electronic data interchange (EDI) standards affecting electronic business transactions
  • HITECH Act — privacy changes in Subtitle D affect electronic exchange and use of personal health information (PHI)
  • Health Insurance Portability and Accountability Act — regulates how PHI can be exchanged and used
  • HL7 — used to communicate with hospitals and/or EHR systems
  • ICD-9-CM and ICD-10-CM — a system of diagnostic codes for classifying diseases
  • National Uniform Billing Committee's UB-04 Data Specification — specifications for UB-04 claim forms[20]
  • National Uniform Claim Committee's 1500 Health Insurance Claim Form Specification — specifications for 1500 claim forms[20]

As of 2015, the primary standards body affecting the development of PMSs is the Electronic Healthcare Network Accreditation Commission (EHNAC), which offers accreditation to software providers through its Practice Management System Accreditation Program (PMSAP).[21] According to the EHNAC, "the PMSAP has been created for PMS vendors who provide the essential tools to optimize workflow and streamline efficiencies, enhance revenue cycle management and reporting, and seamlessly integrate with electronic health record systems."[22] It also assesses the software's ability to conform to applicable standards and regulations affecting PMS development. The accreditation requirements are broken into eight sections, addressing topics including privacy and confidentiality, technical performance, security, and actual software functionality requirements.[19]

Notes

This article reuses an element or two from the Wikipedia article.

Further reading

External links

References

  1. Correa, Cindy (2011). Getting Started in the Computerized Medical Office: Fundamentals and Practice (2nd ed.). Cengage Learning. ISBN 9781435438477. https://books.google.com/books?id=OYNyTXJi7dwC&printsec=frontcover. Retrieved 17 June 2015. 
  2. Mikuriya, Tod H. (28 June 1972). "Hardware, Software Don't Fulfill Doctors' Needs". Computerworld 6 (26): 8. https://books.google.com/books?id=_GFqy-RrTtAC&pg=PT7. Retrieved 17 June 2015. 
  3. Ryan, George A.; Monroe, K. E. (1971). Computer Assisted Medical Practice: The AMA's Role. American Medical Association. pp. 98. https://books.google.com/books?ei=8h-CVaTtH4X8oASt6YGoAg&id=GT1rAAAAMAAJ. Retrieved 17 June 2015. 
  4. "NCR Package Aids Doctors". Computerworld 12 (33): 52. 14 August 1978. https://books.google.com/books?id=Z4s8fil_zIIC&pg=PA52. Retrieved 17 June 2015. 
  5. "Software Professionals". Computerworld 13 (25): 73. 18 June 1979. https://books.google.com/books?id=rfsvbXyn0ZEC&pg=PA73. Retrieved 17 June 2015. 
  6. 6.0 6.1 "Software/Job Specific/Medical". PC Mag 1 (7): 379. November 1982. https://books.google.com/books?id=vy3cBZkjbZgC&pg=PA379. Retrieved 17 June 2015. 
  7. "Wanted: Medical Office Software". InfoWorld 4 (25): 94. 28 June 1982. https://books.google.com/books?id=ZTAEAAAAMBAJ&pg=PA94. Retrieved 17 June 2015. 
  8. Nutting, Paul A.; Connor, Eileen M. (1984). Community Oriented Primary Care: A Practical Assessment. 2. National Academy Press. pp. 169–170. https://books.google.com/books?id=eHUrAAAAYAAJ&pg=PA169. Retrieved 19 June 2015. 
  9. "Software/Medical". PC Mag 4 (4): 323. 08 January 1985. https://books.google.com/books?id=iwjS--W2mG8C&pg=PA323. Retrieved 19 June 2015. 
  10. "Marketplace: Medical". PC Mag 9 (13): 478. July 1990. https://books.google.com/books?id=ofXGcGVTvoEC&pg=PT478. Retrieved 19 June 2015. 
  11. "Business Card: Medical". PC Mag 13 (4): 394. 22 February 1994. https://books.google.com/books?id=v5YwX3auv0cC&pg=RA1-PA394. Retrieved 19 June 2015. 
  12. Ziesemer, Brandy (2012). "Chapter 10: Managing Health Information Technology". Medical Office Management and Technology: An Applied Approach. Lippincott Williams & Wilkins. pp. 225–258. ISBN 9781608317424. https://books.google.com/books?id=DEd5idlK2ssC&pg=PA225. Retrieved 19 June 2015. 
  13. "Top Medical Practice Management Software Products". Capterra, Inc. http://www.capterra.com/medical-practice-management-software/. Retrieved 19 June 2015. 
  14. "10 Top Medical Practice Management Software Systems". InformationWeek Healthcare. UBM Tech. 12 March 2012. http://www.informationweek.com/healthcare/clinical-information-systems/10-top-medical-practice-management-software-systems/d/d-id/1103318?. 
  15. Torrieri, Marisa (23 December 2011). "Should Your Medical Practice Use Cloud-based Computing?". Physicians Practice. UBM Medica, LLC. http://www.physicianspractice.com/technology/should-your-medical-practice-use-cloud-based-computing/page/0/1. Retrieved 19 June 2015. 
  16. Mitchell, Bob (23 November 2011). "Practice Management & EHRs: Interface or Integrate?". Clinical Innovation + Technology. TriMed Media Inc. http://www.clinical-innovation.com/topics/ehr-emr/practice-management-ehrs-interface-or-integrate. Retrieved 17 June 2015. 
  17. Chatham, Lea (29 May 2014). "How Important Is EHR and Billing System Integration for Medical Practices?". Getting Paid. Kareo. http://gettingpaid.kareo.com/gettingpaid/2014/05/how-important-is-ehr-medical-billing-software-integration-for-medical-practices/. Retrieved 17 June 2015. 
  18. Bresnick, Jennifer (8 June 2015). "86% of Providers Aim for Integrated EHR, Practice Management". HealthITAnalytics. Xtelligent Media, LLC. http://healthitanalytics.com/news/86-of-providers-aim-for-integrated-ehr-practice-management. Retrieved 17 June 2015. 
  19. 19.0 19.1 Barrett, Lee; Jopp, Devin (March 2015). "Practice Management System Accreditation Program (PMSAP) For The Healthcare Industry, Version 1.0". Electronic Healthcare Network Accreditation Commission (EHNAC) and Workgroup for Electronic Data Interchange (WEDI). pp. 27. https://www.ehnac.org/program-criteria/. Retrieved 19 June 2015. 
  20. 20.0 20.1 "Become a Subscriber: National Uniform Billing Committee Official Data Specifications Manual". National Uniform Billing Committee. 2015. http://www.nubc.org/subscriber/index.dhtml. Retrieved 19 June 2015. 
  21. "Programs: Practice Management Systems". Electronic Healthcare Network Accreditation Commission. https://www.ehnac.org/practice-management-system-accreditation-program/. Retrieved 19 June 2015. 
  22. "Practice Management System Accreditation Program (PMSAP)" (PDF). Electronic Healthcare Network Accreditation Commission. http://www.ehnac.org/wp-content/uploads/2014/09/EHNAC_PMSAP-Data-Sheet_FINAL.pdf. Retrieved 19 June 2015.