Directors of outpatient methadone clinics always are balancing costs against benefits. Because they need to manage within budgets, they must be absolutely certain that improvements will yield an appropriate return on investment (ROI). Today, many technology vendors are making their software solutions very affordable, creating new opportunities for methadone clinic directors to upgrade service delivery. As a result, this is an appropriate time to revisit the considerations for evaluating methadone clinic management software.
Among the top goals of many clinic directors is having staff spend more time caring for patients and less time on administration, maintaining better records, and producing more effective reports. However, any effort to improve operations must be balanced with budget considerations. Let's look at these areas and determine what the appropriate software solution must have to accomplish these goals.
Record keeping. Working in a substance abuse clinic requires a great deal of focus and energy because of the number of simultaneous activities. Patients are anxious to receive their medications, meet with their counselors, and get on with the day's activities. The clinic must comply with federal, state, and local laws, regulations, and procedures; provide a multitude of services for their patients; and bill patients, Medicaid, and private insurance carriers. Other activities include:
* receiving, logging, and tracking class 2 narcotics, such as methadone;
* writing orders and dispensing medications;
* accounting for every milligram of medication in inventory, dispensed, or destroyed; and
* scheduling and tracking a range of supports such as social services, mental health services, and testing services.
A meaningful software solution should manage all of these functions and more. Record keeping should happen automatically in the course of a clinic's normal daily work. By this we mean that accepting medication shipments, scheduling appointments, writing orders, and providing patient services should be logical, automated, and provide all the information the clinic needs. Thus, clinic management software must be intuitive, as well as easy to understand, use, and configure.
Configurability. The ability to configure software to work as the clinic operates is important. Some software requires clinics to change their practices to adapt to the way the software has been designed. On the other hand, configurable software mirrors a clinic's procedures and rules by allowing clinic managers to answer questions and define their processes within the software. As a result, work methods do not need to be changed, and people are instantly more comfortable with the software solution. Configurable software allows for adaptation to changing procedures and rules, thereby protecting the software investment well into the future.
Signatures. Procedures can be enhanced by combining familiar models with new technology. Many items can be "signed in" one of several ways, depending on state laws and regulations:
Wet signatures are ink signatures on paper--the old-fashioned way. Almost every state requires that one or more documents (e.g., medication orders) be printed, carry wet signatures, and be placed in a patient's permanent file. Software applications must be able to print every form or screen that any state might require to have a wet signature for the permanent file. Some software prints orders on labels for signatures, thereby saving space in the file as multiple labels can be affixed to individual sheets of paper.
Electronic signatures require an electronic signature pad, such as those at retail stores for signing for a credit or debit card purchase. The person signs the electronic pad, and the signature is stored in a database along with a record of the item being signed for. Methadone clinic software can allow physicians to sign orders, patients to sign for receipt of medications, and counselors to sign notes or treatment care plans using an electronic signature pad.
Digital signatures require no additional hardware. One digitally "signs" by reentering one's log-in identification and a special signature password. Thus, a counselor can digitally sign his notes or a physician an order by entering his digital signature data at the time the activity is completed.
Clinics should check with their state about what can be signed for in what ways.
Tracking accreditation and licensure requirements. Methadone clinics must maintain their accreditation status, as well as staff members' certifications, licensures, and ongoing educational requirements. Software should provide treatment care plan functions that the various accreditation bodies have accepted. It should track and report on what staff members must do to stay current.
Streamlining payment. The software must have the capability to record direct payments from patients and invoice third-party insurers. Billing and payment can be handled one of three ways:
* Service bureau. Some companies offer a service bureau approach that eliminates the need for clinic-based billing staff and the pressure of managing the process of continuous billing and rebilling.
* Data export. Another approach is to allow for an extraction and transfer of data to, for example, a hospital-based billing solution.
* Clinic-based billing. A separate billing module allows the clinic itself to perform and manage the billing process.
The most appropriate and cost-effective solution varies based on a clinic's needs.
Clinic management software applications are built upon databases. Databases need to meet certain criteria to be sufficiently robust and offer full data protection.
Security. No clinic director would want or allow records to be changed by unauthorized staff members. The database should apply security policies, as well as include extensive audit trails regarding who changes records, what the changes are, and when changes are made. In addition, some software providers have created advanced security protocols that limit whether an individual can even view, much less change, certain types of information. The integrity of patient information is better protected when the software is designed from the outset to enforce this type of security.
Easy maintenance. Such protection should not come at a heavy burden. The database should be easy to maintain, and IT staff should be able to support the database on a full-time or contract basis for a reasonable cost.
Full suite of reports. The software should offer a full set of reports, especially those required to manage the clinic's day-to-day business. While each clinic may vary to some degree in how it chooses to deliver services, the type of information required to manage clinics is often very similar. A software provider with industry experience should provide most or all of the necessary reports and make them configurable (such as by date range or by various patient categories). For reports that are not included or for special reports, the software vendor should provide either a built-in report writer or the ability to access the database via third-party report writers.
Electronic transmission. One of the trends that software must continue to address is the capability to transmit or accept data electronically. Most software vendors provide this capability. Some have taken this a step further by allowing laboratories to transmit test result data to the clinical management application and directly populate the appropriate fields in patients' records. This capability eliminates data entry errors, speeds up data availability and, of course, reduces costs.
Data aggregation. Some software companies offer the ability to store and aggregate data for multiple clinics. Consolidation within the industry is happening more and more, and companies are looking to perform their business analyses across entire corporate entities. For those organizations, software should have multiclinic capabilities that allow patients to be served when and where it is most appropriate, and patient information should be available to all clinics in the group.
Still, when all is said and done, the solution must deliver an appropriate ROI. Some software providers make ROI easier by spreading payments for support and upgrades over time. ROI is achieved easily when the software costs less than the costs of data entry, preparing for audits, or having extra staff record data manually. Consider several cost components:
* purchase or lease price of the software;
* cost of database maintenance;
* technical support costs;
* upgrades' costs;
* training costs; and
* equipment costs, such as automated dispensing pumps, label printers, receipt printers, and digital cameras for patient photographs in the software (the cost associated with purchasing new hardware to run the software also should be considered, although these costs may be capitalized).
Make sure that the software package includes effective training and technical assistance, as well:
Training. Many experts agree that the most effective software training method is on-site training provided immediately before the clinic begins to use the application. Even more useful is having the trainer remain on-site to answer staff questions during the first few days the clinic uses the software. Having someone available to answer questions and coach the staff is especially crucial to fostering fast software adoption. It is at this early time that staff members judge how easy or difficult the software is to learn and use, thereby influencing their comfort level with the software.
Technical assistance. People make mistakes and forget what they have learned, especially when the software is feature-rich. A technical support team must be accessible year-round to answer questions or correct errors.
The opportunities for clinic directors to upgrade their operations have never been greater. By evaluating solutions within this framework, managers can allow their staff to meet their goals, increase service quality, create a better workplace, and deliver services more cost-effectively and efficiently than ever before.
David Blumenthal and Ray Stoddard market software solutions for Netsmart Technologies, Inc. To send comments to the authors and editors, please e-mail email@example.com.…