Medical practice management system
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. 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. 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. 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.
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. 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.
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. 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."
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:
- ANSI X12 — electronic 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
- National Uniform Claim Committee's 1500 Health Insurance Claim Form Specification — specifications for 1500 claim forms
As of 2015[update], 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). 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." 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.
This article reuses an element or two from the Wikipedia article.
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