Southern California PSYCHIATRIST Volume 44, Number 3 NOVEMBER 1995 Newsletter of the Southern California Psychiatric Society Some welcome computers as an engaging diversion. Others fear for their lives. This column will provide a gentle introduction to all aspects of computers in psychiatry: billing and scheduling programs, computer-administered diagnostic programs, and psychiatric home pages on the World Wide Web. Each month I will consider one topic or program, starting this month with PM/2, a popular program for billing, scheduling, and writing progress notes. There are several office-practice programs written for psychiatrists. Generally, the heart of these programs is a billing module that generates a respectably formatted bill. Most include a primitive word processing program for progress notes, a system for writing prescriptions and recording lab results, and some have a calendar for scheduling appointments. Unfortunately, almost all run only on IBM-compatible, so Macintosh owners have few choices. Some software developers advertise that their programs will run on a Macintosh under Soft Windows, which is emulation software that runs DOS and Windows software on a Mac. This is too slow to be practical, however, so if you want to use dedicated psychiatric software, go IBM-style. No need to spend a bundle-these programs are relatively simple and will run well on any machine with a 486 or better chip. The advantage most computer programs promise over a written record is primarily elimination of repetitive work. If one enters medication instructions, for example, the program can print out a prescription, and also enter the information into the patient's medical record. For most psychiatrists, however, the biggest time-savings will come in billing. Once you have entered all the appropriate information about yourself and the patient, these programs will fill in standardized billing forms, such as the HCFA-1500, so one can produce the bills each month by simply pointing and clicking. PM/2, the eponymous program from PM/2 Practice Management Systems, typifies the cottage industry roots of most psychiatric software: a small-release feel, DOS-only, and clearly a labor of love. What elevates PM/2 above similar programs is the instinct for clarity of its author, New Jersey psychiatrist Richard Kaplan. The manual is very well written, and the overall layout of the program is sensible and organized. This is important, because, as a DOS program, installing and trouble-shooting may require delving into such things as "config.sys" files, a daunting task for a computer neophyte. Easing the way are context-sensitive help screens. These screens are well written, like the manual, although neither provided enough detail to consistently answer my questions. A safety net for many in the past has been Dr. Kaplan himself, know to return calls late into the evening for urgent problems, and uniformly helpful. He recently began charging for telephone assistance after the first 30 days, but he says this is only to encourage use of his free Fax and e-mail support services. One could use a stand alone accounting program, such as Quickbooks (from the makers of the ubiquitous Quicken) along with a stand- alone PIM and a word processing program, and dispense entirely with PM/2-type program. For most, however, PM/2 is much simpler to use than dedicated accounting programs. Psychiatric billing requires special formats and payment tracking that one can barely squeeze out of a general program, and PM/2 does all the work for you. Other nice features of PM/2 include pull-down menus for DSM-IV and ICD-9 diagnoses (although non-psychiatric codes have to be added by the user), support for electronic claims submissions, a batch mode to rapidly enter billing charges at the end of a month, and billing support for primary and secondary insurance. The treatment planner overall is more work than it is worth. Beyond the billing module, however, users who want to keep their records on computer would do better to get a dedicated calendar/address book (usually called PIMs, or personal information managers) to manage their schedule, and use a stand- alone word processing program. These programs are easier to install and use, are more versatile, and contain advanced features like spell-checking and print-previewing onscreen. One loses the integration of function of a psychiatric office management program, but the greater sophistication of these stand-alone applications makes it worth it. A concern which applies to all medical records on computer is security, especially if one uses them as the primary patient record. The lowest level of security is a password, which will prevent most casual intrusions but will not stop a moderately determined attempt by a knowledgeable user. PM/2 uses password protection, and, for clinical records, a home-grown encryption routine. The best encryption routines are essentially impenetrable. I didn't test PM/2's encryption routine, but the manual warns that it is not designed to stop an expert. And even encrypted files may be inadequate in a malpractice case, as it is difficult to prove they are unaltered. Time-stamping, a new technology the authenticates both the contents and time of last alteration of a file, solves this problem. I will discuss time-stamping in a future column. PM/2 costs $600.00 in its basic configuration, and an additional $300 for either a multi-user or network capable version. Dr. Kaplan plans release of a Windows 3.1 version in a few months. The upgrade is free for recent purchasers, $300 for other users. PM/2 Practice Management Systems, Inc., 285 Engle Street, Englewood, NJ 07631. (201) 871-2039. Highest possible rating = 5 computers Rating for PM/2 = 3.5 Copyright (c) 1995 Southern California Psyhiatrist, newsletter of the Southern California Psychiatric Society. Opinions expressed are solely those of the author. ------------------------------------------------------------------ The Maryland Psychologist March/April 1996 Issue 4 V. 41 PM/2 - Practice Management 2 - Rel 2.9H A Practice Management Software Review by Dennis Pitta, Ph.D., University of Baltimore Overall Summary Our review of PM/2 is based on a test using simulated data, without actually using it in the management of a practice. PM/2 overcame our prejudice that ease of use comes from Microsoft Windows applications alone. PM/2 is a sophisticated DOS based practice management program featuring considerable ease of use. The latest release offers electronic billing and relatively easy database management. Furthermore, it allows optional electronic claims submission and multiple practitioner use on a local area network. Uniquely, PM/2 is set up for electronic claims submission to either of two clearinghouses, Equifax and Teleclaims, and allows adding other clearinghouses easily. We did not test electronic claims submission in our survey. It handles HCFA 1500 forms and comes with clear, well designed documentation in loose leaf form. Since it is a DOS based program, it offers the ability to run on older, less capable computers. The vendor suggests using a 80486 ('486) system with a hard disk, but the computer should run on older systems too. It is a clear, menu driven program which is easy to operate, and is filled with neat features that will enhance practice management productivity. PM/2 is well worth exploring. It is a professionally written program featuring all the pieces necessary for successful practice management. Its most visible benefit may be its cost effective multipractitioner pricing. One competitor, Shrink 3, charges $250 for each additional unit of four practitioners, which can be expensive for larger practices. In contrast, PM/2 charges a flat rate for any number of practitioners. Overall Description PM/2 was written by a psychiatrist with professional programming skills. The overall program contains all of the features needed by a solo or group psychiatry practice as well as the additional prescribing and treatment features needed for psychiatric practices. While written for DOS, PM/2 will run under Windows 3.1. It contains numerous pull down menus to aid in practice management procedures. Installation and Setup As the third in a series of software we have surveyed, we have come to expect effortless installation and easy operation. PM/2 met our expectations. Installation from the single 3.5" diskette was very simple and installation was very easy. all Overall Operation Using sample data, we were able to test the tasks involves with practice information and billing. Setup requires entering clinic, therapist, and patient information. Data entry is preformed using face sheets. One notable user friendly feature helps with data entry. When entering new information not yet contained in the database, like a new insurance company, the program automatically asks if the company should be added. If the user adds the information, it will be added to the insurance company list and be available for future use via pull down menus. After setup, the appointment scheduler is the heart of the program, serving not only as a scheduling aid, but as a data collection instrument. Once appointments are entered and confirmed, they are available for the billing module. Billing is superb! PM/2 avoids some of the problems of other programs by allowing a great deal of customization. As one example, if you want to use dual window envelopes, you can print your clinic information on the left top of the page to be visible in the top envelope window. If you choose to enter you address instead, you may choose the center option. Among the many unexpected features, one struck us as indicative of the quality of PM/2. One can run a series of diagnostic utilities. They allow solving in case of a system problems and can actually save time and frustration in running your practice. Technical Support FAX based technical support is free for life, telephone support is free for the first thirty days. In addition, three telephone support plans are available suitable for several different practice sizes. Our single call to technical support was answered promptly and courteously. The variety of plans and free FAX support earns support an excellent rating. Electronic Claims Submission Our investigation of electronic claims submissions was restricted to exploring the ECS portion of the program and reading the documentation. In contrast to other programs, PM/2 offers more user choice. It supports both Equifax and Teleclaims. Equifax requires an annual user fee while Teleclaims does not. Both charge 47 cents per claim. Use of the ECS module appears to be straightforward. As proof of the care and concern inherent in PM/2's programming, it allows a user to designate and set up other electronic clearinghouses. It is a simple matter to enter the appropriate identification and communications settings and then connect to the clearinghouse. MPA is currently identifying economical clearinghouse sources and PM/2's ability to exploit easy setup promises very inexpensive electronic claims submission. Documentation Documentation consists of a 124 page loose leaf style manual with 11 chapters covering topics like Files, Patients, Visits and Payments, Clinical Functions, Miscellaneous Data Base, Billing, Insurance, Reports, the Forms Generator and Utilities. The arrangement is logical and follows the structure of the program. While the quality of the manual does not match that of a mainstream program like Microsoft Word or WordPerfect, it is clear with numerous screen shots to illustrate program operation unambiguously. In addition, a quick reference guide comes with the manual which summarizes each of the 32 hot keys - which help to jump form one procedure screen to another and consist of pressing the [Alt] key in combination with another single key. Help is available by pressing the familiar [F1} key. Documentation rates a very good. Pricing The company quotes the following prices for the base program and optional units. Notably, PM/2 carries a full 30-day money back guarantee which allows an almost risk free trial. The price for an office with multiple practitioners connected to a LAN with electronic billing is $1500, considerably less than the base price for Shrink3 ($2467), but is a bit more expensive than the $1144 for Therapist Helper. In contrast, a solo practitioner desiring electronic billing capabilities would pay $900, in contrast to 1295 with Shrink3 and $894 for Therapist Helper. Overall, the pricing is competitive and represents a very good value, especially for rather large group practices. PM/2 - Practice Management 2 Rel 2.9H - for IBM compatibles only Price PM/2 Practice Management 2 - Rel. 2.9H BASE SYSTEM $600 Optional multipractitioner support $300 Optional LAN support $300 Optional Electronic claims submission $300 Technical support plans - Fax support only Free for life Priority telephone support (three levels) all use 800 line Plan A - priority telephone support $50 per month Plan B - normal telephone support $25 per month Plan C - as needed support $10 per 6 min unit PM/2 Practice Management 2 - Rel 2.9H Available from: Practice Management Systems, Inc. 285 Engle Street, Englewood NJ 07631 (800) 874-2159 Copyright (c) 1996 Maryland Psychological Association. Reprinted by permission. The opinions expressed herein are solely those of the author and do not represent an official position of the Maryland Psychological Association.