The appropriate place to start an article on practice management systems is surely with a workable definition of precisely what a practice management system is. To quote the Wikipedia article on the relevant software:
‘Practice management software (PMS) is a category of software that deals with the day-to-day operations of a medical practice. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payers, perform billing tasks, and generate reports.
The desktop variety is intended to be used only on one computer by one or a handful of users sharing access. Client–server software typically necessitates that the practice acquire or lease server equipment and operate the server software on that hardware, while individual users’ workstations contain client software that accesses the server. Client–server software’s advantage is in allowing multiple users to share the data and the workload; a major disadvantage is the cost of running the server. Internet-based software is a relatively newer breed of PMS. Such software decreases the need for the practice to run their own server and worry about security and reliability. However, such software removes patient data from the practice’s premises, which can be seen as a security risk of its own.’
This Wikipedia definition is a competent one, but it is also necessary to consider the matter from another angle to gain a more complete picture. The definition provides a good account of what a practice management system is, but this definition only offers a very basic understanding of what a practice management system does. An understanding of this vital utility is more important to the veterinary nurse in practice than knowing the precise technical capabilities or the advantages and disadvantages of this or that particular format.
The definition must, therefore, be expanded to include that a practice management system needs to be capable of nothing less than the co-ordination of all of the information required by a veterinary practice to discharge its functions. This is no small task — client and patient records must be kept securely and updated accurately, diagrams of dental, skin and ophthalmological conditions must be stored, attachments in the form of x-rays, magnetic resonance image (MRI) studies, digital imaging and communications in medicine (DICOM) images, video files, jpegs, pdfs and text must be held, laboratory reports must be collected, appointments must be tracked, the waiting list must be co-ordinated, the daybook must be maintained, stock must be controlled, reminders must be set up, callbacks must be recorded, invoicing must be watertight and any number of reports must be generated.
In short, a practice management system needs to be precise, versatile, reliable and easy to use. Lives depend on this being so.
The history of practice management systems
Although it may be difficult for the younger generations to appreciate, there was indeed a time before computing. Back then, the veterinary practice was dependent in the most absolute sense on its jealously guarded physical records. Index cards, paper notes, old film x-rays and so on were stored in filing cabinets or larger dedicated archives, then located and retrieved as needed.
But this was scarcely an ideal system. As even the most casual of inquiries will suggest, something as simple as a spilt cup of tea could herald disaster for a practice. Records could be (and were) damaged or destroyed with alarming ease, an inadvertent misfiling could mean that a vital document was effectively lost without trace, and even when everything was running smoothly the system’s navigation index could be an impenetrable puzzle without the help of someone trained to use it.
While this system represented the best that could be genuinely done at the time with the technology that was available, it is unsurprising that modern systems that could remove these vulnerabilities and improve on the delivery of vital services were so enthusiastically embraced by the veterinary profession.
Features of modern practice management systems
A list of the features offered by a modern practice management system is, by nature, a long one. While older paper-based systems were limited to one function only — simple information storage — modern systems are (and must be) capable of offering much more than such a relatively modest objective. From the perspective of a veterinary nurse, this is a useful and even an essential feature — instead of having to use a different system for each and every function required, why not use just one good system to properly deal with all of the challenges of a modern veterinary practice?
This article will consider some common features of practice management systems, their uses, and how this impacts on the duties of a veterinary nurse.
Client and patient record handling
This is probably the most basic of all the functions, and perhaps the most vital. The separation of the client’s details and the patient’s details is a deliberate one, and it is one that should be considered important in light of the different purposes for which the information is needed.
As with the old paper systems, a practice management system stores a client’s name, address, contact information and so on. This allows a practice to get in contact (and make the all-important makes-it-all worthwhile kind of phone call telling someone that their beloved pet has recovered, that they are well and truly on the mend and that they can come home now), address the invoice, and even arrange some thing as simple as being able to address the client by name in the waiting room. The latter might sound trivial, but this simple courtesy can reassure a client at what might well be a stressful time.
‘Textual notes are no longer the extent of veterinary information taking, and much more information must be stored in a manner that permits easy access, easy updating and easy storage.’
But it is information stored on the patient that is of the highest priority, and basic details are only the start. Textual notes are no longer the extent of veterinary information taking, and much more information must be stored in a manner that permits easy access, easy updating and easy storage.
As has earlier been touched on, this vital information takes many possible forms. At the least technologically demanding level, the aforementioned diagrams of dental, skin and ophthalmological conditions are a common record in a patient’s file and it will be necessary to refer to them throughout the lifetime of the patient to track any progress or deterioration. Laboratory records, while not particularly technically complex either, will also need to be stored along similar lines for similar reasons. But, at a more demanding technical level, other kinds of attachments are necessary. DICOM images (potentially in considerable numbers) and video files (potentially of considerable length) must also be stored indefinitely and they will place a greater strain on the system than simple images and plain text would. Finally, high-resolution x-ray images and MRI studies will place the greatest strain of all on the system and, since they will also likely be of the greatest importance, their secure storage will need to be a high priority. After all, an expensive MRI scan is not resorted to lightly and having to do one twice because of a mistake with storage may put the patient’s health and the client’s patience in jeopardy.
Table 1. Features of practice management systems
|
Appointment booking, analysis and management
In previous years, a practice’s appointments were handled by the low-tech expedient of a receptionist, a diary and a pencil. This worked perfectly well, but new technology has allowed practices to enjoy greater efficiency and more options than such a basic method could realistically provide. The migration from recording appointments on paper to recording appointments on a computer was a simple step that allowed for useful gains at minimal expense. It is now far simpler to analyze the quantity, frequency and type of appointments, with corresponding gains in terms of being able to use the quiet times for a useful purpose instead of wasting the time and being able to predict a busier time based on past trends and having more staff or resources to hand in anticipation. For the veterinary nurse, this means more time spent helping patients and less time either filling time that could be put to better use or struggling to cope after being overwhelmed by a sudden surge.
Stock control
As with previously discussed benefits, the migration from paper records to digital ones has allowed for greater efficiency, more security and elimination of previous problems in the field of stock control. Instead of stock being tracked manually, an automated alert when something is running low removes the possibility of a vital medicine falling through the gaps and running out when it is needed urgently. For the veterinary nurse at the sharp end of clinical practice and the stricken patient in their care, the benefits of this security surely cannot be stressed enough.
Reminders, callbacks and letters
While not apparently an issue of immediate concern to a veterinary nurse, the use of practice management systems to assist with reminders, callbacks and letters increases both the client’s awareness and the likelihood that they will bring their pets back into practice to be seen. A personalized letter reminding a client to bring the patient back in after surgery so they can be checked over may well spot something of importance before it becomes urgent or past help. The reverse is also true — after all, reminders to get booster vaccinations today may mean one less sick pet in 6 months’ time.
Communications
In a similar vein to the above, the use of practice management systems to send automated communications was a thoughtful innovation. The busy client might not check their post or be able to answer the phone, but a text message sent straight to their mobile can get through wherever they are. If, for example, they are waiting anxiously for news of their pet, the peace of mind offered by even a brief message will be welcome indeed. Similarly, well-developed practice management systems also take into account the possibility that vets and veterinary nurses might be required to attend to a patient outside of the practice. Keeping in direct contact with the practice and therefore remaining able to access the wealth of data stored in the practice’s files could make all the difference during a home or farm visit.
Creating staff rotas
A veterinary practice is dependent on having the right people in the right place at the right time, and modern practice management systems are capable of assisting with the creation of the rotas to make sure this happens reliably, quickly and without fuss. Even the largest or smallest of practices stand to benefit from simply sorting their shifts out with a click of the mouse instead of relying on a confusing struggle with paper-based techniques, and the time saved by taking care of this long-standing headache quickly and without stress makes the veterinary nurses’ shift patterns something that can be relied on instead of a cause for confusion.
What this means for veterinary nurses
The veterinary nurse in practice now has dramatically more information — literally at their fingertips — and therefore has more options and opportunities that can be pursued in the course of caring for their patient. These changes should be embraced wholeheartedly and it is not an exaggeration to say that a confident command of a practice management system is now as valuable a skill to veterinary nurses as their medical knowledge — the latter cannot be used to the fullest potential without the former.
Ultimately, the benefits of practice management systems are threefold. They are of benefit to practice staff, and particularly the medical staff, because of the ability to deliver better care more thoroughly and with greater efficiency than ever before. They are of benefit to practices as a whole because the increases in productivity, greater information security and smoother co-ordination between elements of the practice brings real gains in terms of income, public image, staff retention, and a whole range of other factors. Finally, and perhaps most importantly of all, they are of benefit to patients, who now receive better care than they ever have.
Conclusion
A practice management system is a wise investment indeed for a veterinary practice, and learning how to get the best out of one is a similarly wise investment of time and effort for the modern veterinary nurse. Dramatic improvements on past working practices are just the start. Practice management systems offer genuine gains in terms of efficiency, utility and information access to the veterinary nurse, and productivity gains, cost savings and improved business prospects for veterinary practices as a whole. The days of handling everything with pencil and paper are long gone — practice management systems are an indispensable asset for the veterinary practice of the 21st century, and a magnificent tool for today’s veterinary nurse.
Key Points
- Practice management systems offer great gains on previous systems and working practices.
- Modern veterinary practices rely heavily on the storage of various kinds of information, and must be able to access this reliably and accurately at short notice.
- A veterinary nurse must have a sound grasp of how to successfully operate a practice management system to be able to offer the very best of care to patients.
- Not being able to use a practice management system limits a veterinary nurse’s options severely and has corresponding risks for patient care.
- Return on investment is high and continuous improvements mean that this trend will continue to favour practices.
- Combining a large number of services in one format means productivity gains, a reduction in stress and more time to help patients.