General Technology,
Season 1,
56 MIN 30 SEC

Episode 102: Electronic Health Records (EHR)

August 08, 2017

This Episode’s Sponsor. Coupon Code: Either “ROYROB” or “ROBROY” — you choose!


Rob and Roy discuss EHR, EMR, and Practice Management systems.  Do you need one? How can they help your practice? With special guest, documentation expert Maelissa Hall of

Show Notes
  • :13

    What is EHR? (EMR, EHR, Practice Management System, Meaningful Use)

  • 3:16

    Do I have to have an EHR?

  • 4:26

    Reasons to consider ONC Certified EHR

  • 7:11

    Practice Management Systems

  • 12:35

    What Features To Look for in a Practice Management System

  • 16:40

    PCT Hot Tech Tip

  • 19:09

    Why it’s important to never use tech you haven’t tested

  • 23:59

    Billing, credit cards

  • 26:29


  • 28:08

    Guest Spot – Maelisa Hall

  • 37:12

    Random Describe Question for Maelisa

  • 40:58

    Insurance Filing

  • 44:41

    Client Portal

  • 50:48

    Group Practices

Episode Transcript
Rob Reinhardt: Therapy Tech with Rob and Roy. The most fun therapists can have listening to a podcast about technology. This episode of Therapy Tech with Rob and Roy is brought to you by Therapy Appointment. You provide the therapy, we provide the rest. Find out more at ... Hi, I'm Rob Reinhardt from  
Roy Huggins: And I'm Roy Huggins from Today we're gonna talk about EHR. Well, that means electronic health records, but the term actually means a lot of different things, doesn't it Rob?  
Rob Reinhardt: Yeah. There's a lot of permutations, it's kinda taken on a lotta meanings over the last several years.  
Roy Huggins: Permutations. That's how you know that Rob has math background. He used that word.  
Rob Reinhardt: Woohoo!.  
Roy Huggins: Okay.  
Rob Reinhardt: There'll be a quiz on that later.  
Roy Huggins: Yes, yes.  
Rob Reinhardt: You hear about EHR and EMR and Practice Management System; and people kinda use them interchangeably. And that's okay. But it's probably important to know some of the distinctions.  
Roy Huggins: Well, why don't you tell them to us Rob. That's like the first thing we wanna talk about right. What is an EHR / Practice Management System / EMR / PMSQT.  
Rob Reinhardt: Yeah so, I don't know if we can cover that last one. But EMR is electronic medical record. It's very focused on the actual medical record of a person, if we're getting down to the technical definitions. And you're not hearing EMR thrown around as much as EHR, Electronic Health Record. That's talking about the broader package, of not just the actual record but what you can do with the record. EHR is actually a phrase that's connected to Meaningful Use. And that's when we get into the technical definition of EHR. So, the whole idea of the Meaningful Use Program, which was part of the Affordable Care Act, was to make healthcare more efficient; save money by making communications and recordkeeping more efficient. So, you could go to one doctor, and then they refer you to a specialist; and they can send all that information right to the specialist. And that specialist theoretically wouldn't have to ask you 100 questions again, they'd already have gotten your record. And so, the Meaningful Use Program provided incentives as well as penalties for medical organizations to put what's called an interoperable system in place. Interoperable meaning hey, it will communicate with other EHRs, and accomplish what we just talked about with the transfer of records.  
So, medical facilities could get payments, and they also paid penalty if they don't put such a system in place; and Meaningful Use certified EHR.  
Roy Huggins: So, how's that goin', that program?  
Rob Reinhardt: Well, you know, it's got its good and its bad points. It's government regulated, you know, it involves a lot of parties. So, in some ways ... You know, the theory of it is great. But putting it into practice ... it's kinda like the convolution of HIPAA, having to address both large hospital organizations, but also solo providers that are in private practice; it gets pretty complicated.  
Roy Huggins: We keep hearing that we need to have these electronic records, and that the government will make us have electronic records; or they do already. People are starting to get the different messages and different times here. So, when do I actually need a Meaningful Use certified or ONC certified Interoperating EHR system? When do I need that Rob?  
Rob Reinhardt: Uh, you ... I don't know if you'll ever need that Roy.  
Roy Huggins: Me.  
Rob Reinhardt: 'Cause if we remember correctly, I don't even think you keep any records. Right?  
Roy Huggins: I don't keep records at all. That's right, yeah. That's the rumor we're spreading for some reason.  
Rob Reinhardt: No, but seriously, in the realm of mental health clinicians, very few of us need to have an ONC certified Meaningful Use EHR system. Where, in fact, most of us are exempt from that whole program. Primarily, psychiatrists, because they are MDs, and nurse practitioners are included in that incentive and penalty program. And then only if they're really doing a lot of Medicaid and Medicare business, do they need to be particularly concerned about it. 'Cause that's where the penalties come in.  
Roy Huggins: Right.  
Rob Reinhardt: There are some other reasons you might want to give consideration to have one. I think these are the primary ... There's been a lot of talk, over the last five years, that, "Oh, mental health clinicians are gonna be required to do this soon too."  
Roy Huggins: Right.  
Rob Reinhardt: And there's been proposed legislation; and not much has really actually happened with it. There's some people in the mental health field who want it to happen. Other who are opposed to it. So, you want to keep your eye on maybe someday we will be required to do it. But I think it's more likely that people will just gradually move toward it because there's business reasons to do it. So, more and more healthcare is gonna become centralized; with a Primary Care physician directing your care, and sending you to specialists. And so, it may be the case where you're gonna get more referrals if you have that kinda system in place, that can receive such referrals from people who already have that kind of system in place.  
Roy Huggins: Right. And just to make sure everyone's on the same page with us; we're specifically talking about the interoperating systems, the ones that talk to each other. Not just any old electronic record system online.  
Rob Reinhardt: Yeah, and a lot of the ones that our field are used to aren't ONC certified. Now they may be working toward that, because they see the writing on the wall down the road as well. But, you know, as we talk about and as you research systems for yourself, you might wanna look at, "Hey, is this ONC certified? Is it not? How important is it to me now versus looking at that for the future."  
Roy Huggins: Right, right. And so some people who are a little more up on the national effort for electronic records know that the new program for interoperating electronic health records is MACRA. And MACRA actually includes a lot of things; not just the record system. But those who have been hearing about that and don't really know the details, should know that Meaningful Use is still a part of that; and we as the non-medical mental health professionals are still not part of it. So, everything Rob just said still applies, even with MACRA in place.  
Rob Reinhardt: Right, and for those who may have heard about the prequel to that. PQRS is what MACRA took the place of.  
Roy Huggins: Right.  
Rob Reinhardt: So, if you've heard those terms, it's gonna be more about MACRA now than PQRS; and something else we probably need to mention, we're talking about things on a national scale. Things that are gonna affect all of our audience. But it's important to note that States are sometimes jumping into the game here as well. For example, Minnesota passed their legislation requiring people to use these kinds of systems. It was then amended, because there was a good bit of uproar about the burden that it was gonna place on especially solo and small group providers and so, there is an amendment where they have an exemption depending on certain circumstances. So, it's important that you're paying attention to your State legislation as well.  
Roy Huggins: Right. Well, okay so that's that whole thing. Now that we've covered that, it's probably worth noting that that's not necessarily what we're gonna focus on here. Like, we're mostly gonna focus on just using electronic systems for keeping records; whether it's an interoperating fancy ONC certified one, or just a plain old system where you have records on it. And it's not ONC certified; doesn't do Meaningful Use. And so, that's really what we'll talk about. Now that we've talked about those legality issues. So Rob, help us understand, sorta concretely, the difference between one of these fancy systems, and a plain old Practice Management System, which is what most of us are really looking at using or currently using.  
Rob Reinhardt: Yeah, and so to be clear, we're gonna probably use the term EHR, moving forward, in this conversation. And we're using it in the more generic sense. Not the, "Oh, if I say EHR, it means Meaningful Use certified." We're using it to cover pretty much all these systems. And that's why we wanted to clarify that upfront; that some people will use it in a very specific sense, whereas we're gonna use it in a very general sense.  
Roy Huggins: Right.  
Rob Reinhardt: So when we talk about the actual physical differences apart from the Meaningful Use piece, that really is the difference. So, the certified programs have gone through systems of checks and balances. They've got to achieve certain milestones, they have to have certain functionality in their system; and get that certified that, yes, we provide interoperability and all these other features that we have to have in order to qualify for the Meaningful Use program. Whereas some of these other systems that you hear about have either not taken those steps, or are just starting to take those steps; or in some other phase, either not doing at all, or starting to work toward ... That sort of thing.  
Roy Huggins: Or they just don't see it as kinda necessary to their mission, because they're serving their population.  
Rob Reinhardt: Right. Yeah, they may decide they're not ever gonna do it, and that's fine as well. They are serving a different clientele.  
Roy Huggins: Okay, so what are examples of those. Or should we be naming specific Practice Management Systems; there's so many of them. Right?  
Rob Reinhardt: Well, people can certainly go to and under the blog, I've got links all over the place; to the EHR reviews, the Practice Management System reviews. We couldn't possibly list ... Well, we could list them all off here, but people would get very bored with it.  
Roy Huggins: That would be very boring, very fast. Yeah.  
Rob Reinhardt: Yeah they can go there and see the vast array that is available. And I do have some ONC certified ones up there as well. The key is that ... I focus on systems that do have a bent toward mental health professionals.  
Roy Huggins: Right. Yeah, okay. And so, a lot of those are Practice Management Systems rather than focused on being EHRs. Which is ...  
Rob Reinhardt: Yeah, we should probably clarify what that means. So, when we talk about Practice Management System, you're not just focused on the health record; meaning the information about the client, and how to transfer that. But you're also bringing in Practice Management features like scheduling, billing ... I say Client Portal, Client Portal is technically part of Meaningful Use as well; but you may have some features in there that aren't required by Meaningful Use.  
Roy Huggins: Yeah Client Portal can be a great resource, whether it's Meaningful Use compliant or not.  
Rob Reinhardt: Right, so when we talk about Practice Management System we're talking about giving you a lot of electronic tools to actually make your practice more efficient; and have all the features possible in one place, instead of having to use four different pieces of software.  
Roy Huggins: Oh, okay. Well then in that case, Rob ... I think I'm just gonna do this question every time we have an episode. Which is the best one, Rob? I'm just gonna ask that every time, no matter what we're talking about.  
Rob Reinhardt: The one that fits your practice, Roy.  
Roy Huggins: What? What a great answer.  
Rob Reinhardt: Excellent. By the fourth of fifth episode, we're gonna have everybody saying that along with us. Right?  
Roy Huggins: Yeah, right. Exactly. The one that fits your practice.  
Rob Reinhardt: And we're gonna go to conferences and everybody's gonna walk up to us and go, "The one that fits your practice."  
Roy Huggins: That's right. That's good. That would be good. I'd think we'd like that. Right? Alright.  
Rob Reinhardt: And we've talked about that being not just with EHR, but with any piece of software.  
Roy Huggins: Yeah, that's very true. Sometimes, there's certain kinds of software, where someone asks, "What's the best?" And people go, "Oh yeah, you need to have this." You know, like, "If you wanna do really professional graphic work, you gotta get Photoshop." Right.  
Rob Reinhardt: Right. Exactly.  
Roy Huggins: Or if you wanna do word processing, it's like, you have Microsoft Office. Or if you're on MAC, maybe you're using Pages. But you're probably still using the MAC version of Microsoft Word. Right. Everyone has Microsoft Word. So, people might expect, that there's a best one. But when it comes to these Practice Management Systems and EHRs, there's nothing like that. There's nothing close to that; where there's just like this one that everyone uses, or that's clearly the best, or clearly the most powerful.  
Rob Reinhardt: Exactly. Yeah, another way I'd put it is, there is no Facebook or Amazon of mental health EHR yet; the one that everybody's using.  
Roy Huggins: Right. I like how you said, "Yet," by the way.  
Rob Reinhardt: Yet. Yeah, I mean, they're all working toward that. Or maybe not all, some of them are really niche, and are really focused on a particular demographic. But certainly some of 'em are wanting to be the one go to program. And that's good for us.  
Roy Huggins: Yeah.  
Rob Reinhardt: That means that they're all working very hard to develop new features. I think we're kinda entering a golden age of ... Most of the top tier applications out there, the EHR Practice Management Systems have a lot of the core functionality already fleshed out. And so, now they're getting into, "How do we make this better? How do we add more refined features?" So, we're really entering a really good time for us to find some of these more detailed features we'd like to see.  
Roy Huggins: Absolutely. Yeah, and I'm definitely seeing way more systems pop up, that have these same sets of features. They've got like billing built in, and scheduling built in, and messaging built in; and I'm like, "Man, it's just so many that have that now." And actually, speaking of features, Rob. Okay, so the best one for your practice. So, if I'm gonna determine the best for my practice, it helps for me to know what kind of things my practice needs from a system. Or like, what kind of things do you see people needing? What are the dimensions you use? 'Cause I know you consult with people to match them with a system. Like, what are the things you ask them about? 'Cause you must ask them like, "Do you need this? Do you need that? Do you need that?" Like, what are those features that you ask them to tell you about they need.  
Rob Reinhardt: Sure. And that's where I ask people to start. There's two things I ask people to do when they start to think about what system they want. A lot of people, their first instinct is, "Well, I'm just gonna ask what everybody else uses." And that runs us dow that troublesome road of well, "But what they use, may not be a good fit for you; 'cause their practice might be different." So the first things I ask people to do; first of all, is to think about where their practice is now, and where they want it to be in five years. You know, 'cause that's gonna dictate a lot of the functionality that you wanna have in this system. Not just where you're at now. Let's say you're a solo practitioner now, but you wanna be a group practice with a dozen clinicians in five years. Well, you wanna make sure that you're picking a system that's gonna grow with you. You don't wanna pick something that's focused on solo clinicians; and then two years from now you have to switch again.  
Roy Huggins: Right.  
Rob Reinhardt: So, that's big picture; "Hey, where are you now? Where do you wanna be in five years?" And then you start to look at, "Okay, let's look at the different sets of functionality; the different modules, if you will, of the Practice Management System." One thing to look at is scheduling. "What are the features that you want for scheduling?" You know, "Are you gonna be a solo practitioner where it's pretty straight forward; it's just you and your calendar. Are you gonna be a group practice, where you're gonna have several clinicians, and you wanna be able to see several people on that calendar at once? Do you want to have appointment reminders?"  
Roy Huggins: Mm-hmm (affirmative).  
Rob Reinhardt: Most of the systems have those Automated Appointment Reminders these days. I think, often that alone, pays for the system. You know, when people often ask me, "You know, is it really worth paying $50, $60 a month for me to have this system, for a solo clinician." And I say, "Well look, let's say you have these Automated Appointment Reminders. By that, I mean, automatically, these reminders of appointments go out to your clients; without you having to do anything other than turn on the button that says yes, this client wants appointment reminders."  
Roy Huggins: Right.  
Rob Reinhardt: "If that saves you one cancellation or no-show, because that person got that reminder; you've pretty much paid for the system, for that month.  
Roy Huggins: Right, totally. And by the way, there are of course, like HIPAA and ethical issues around that; which we'll be covering in a later episode.  
Rob Reinhardt: Yeah, we should probably mention ... we forget, we gotta mention that at the beginning of the other episodes. People are gonna have lots of ethics and HIPAA questions about some of our topics. And we'll probably have entire episodes to cover that.  
Roy Huggins: Right, right. So, Rob, when I get a system that has scheduling, will it synchronize with my own calendar; so that it knows when I'm available, and when I'm not?  
Rob Reinhardt: Yeah. That's another feature that people often look for. The tricky part of that, again, comes down to HIPAA. When you talk about synchronizing, there's kinda two directions there. So, lets say you use Google Calendar, like so many of us do; and that's what people are often looking for, "Hey, I wanna be able to see my EHR calendar in Google Calendar. Seeing it in Google Calendar is pretty straight forward for a lot of these systems. They do allow you to export or link their calendar to Google Calendar.  
Roy Huggins: Right.  
Rob Reinhardt: The trick ... and again, there's some HIPAA issues there as well. But the trick is, you're usually not gonna get bidirectional. A couple of systems are dabbling in this-  
Roy Huggins: A couple do, yeah.  
Rob Reinhardt: Yeah. Bidirectional meaning you can make a change in Google Calendar, that now show up in EHR. And a lot of them are hesitant to do that, 'cause they're having to open up their system to allow edits from the outside. And that becomes a security issue that a lot of them don't wanna deal with.  
Roy Huggins: Right.  
Rob Reinhardt: So, some of them do have it. But that's certainly something to consider, you know, "How important is this to me, when I'm looking for a system?"  
Roy Huggins: So, I'll give one HIPAA tip. Just because it's a simple tip that people are gonna be really curious about; we just wanna make sure we nip in the bud. It's time for the Person-Centered Tech Hot Tech Tip. This episode of Hot Tech Tip has to do with using G Suite or also Microsoft 365; in order to get a HIPAA friendly calendar. So, let's say your Practice Management System will let you synchronize the calendar of appointments with some other calendar that you have, like your Apple Calendar. That could be possible, but one of the problems is that the Apple Calendar doesn't do Business Associate Agreements. So, you know, dealing with synchronizing there is kinda rough. However, the cool thing is, G Suite, which is the Google products; includes Google Calendar. And so, you can have a Business Associate Agreement with G Suite. That's one of the cool things about it. It costs about five bucks a months to have G Suite; and then you get the Google Calendar.  
And so, if your Practice Management System is synchronizing your calendar of appointments to the Google Calendar; at that point, it's legal, all around. Microsoft 365 is a similar service that can also do calendar. So, the fact that you can get the Business Associate Agreement with those office services that includes Calendar, is a great way to remain HIPAA compliant, and still synchronize calendars. 'Cause remember, you can view your Google Calendar from your smartphone. Now, you can possibly even have your Google Calendar appear in other Calendar apps on your phone. It's a great way to make sure that you're staying HIPAA compliant, getting Business Associate Agreements where you need them, and still being able to see your calendar.  
Right. So, that's a little teaser for people to think about that. And we'll probably get into more detail about that in HIPAA related episodes.  
Rob Reinhardt: I imagine we will.  
Roy Huggins: Yup. Yup. Yeah. So, the other reason I asked that one, is just to do the whole like, even though it says scheduling in the feature list; it doesn't mean the way the scheduling works will be the same on every system. Like, some systems will do things where you can be like, "As soon as somebody blocks out time, I want the hour after them to not become available. Because I wanna have a rest after the appointment." You know, but others don't do that at all. So, scheduling ... Any of these features will work differently on every different system.  
Rob Reinhardt: Yeah. And this is kind of a sidebar; but I strongly recommend that people, as they close in on the system that they wanna use, take advantage of the ones that do free trial accounts.  
Roy Huggins: Yes.  
Rob Reinhardt: And I always recommend that people get in there and spend a couple hours with it, and create a fake client, and a fake session, and a fake payment, and a fake node; and get in there and actually see what is it gonna be like, what's the learning curve gonna be, is it gonna meet some of the more detailed functionality that I'm looking for. You won't be able to test everything, there's some features you have to turn on, or ...  
Roy Huggins: Yeah, that's right.  
Rob Reinhardt: ... you know, get serious about, put real information in; in order to use. But, you can certainly get a feel for the basics.  
Roy Huggins: I think this is a thing ... We can make another one of our little catch phrases; or like catch concepts. Which is, never use tech you haven't tested.  
Rob Reinhardt: Right.  
Roy Huggins: And people do that a lot. Like, people will get a new app or something, and just start using it with clients. 'Cause I mean, you know, if you haven't thought about it; or you don't have the background that Rob and I do, it kinda makes sense. You figure, well it's supposed to just work. Right? So, I'll just start using it. But here's a really important thing; you should have a really strong familiarity with any new software you get, before you start using it with clients. And, I have a lotta reasons why I think that; but I think, aren't gonna fit in this episode. But we'll certainly talk about in the future.  
Rob Reinhardt: Well, we can probably highlight two really important ones. One, you need to be able to tell your client how to use it.  
Roy Huggins: Yeah that's true. Yes.  
Rob Reinhardt: And two, you know, in order to do your HIPAA risk analysis, you need to know how it works; at least generally, and where the gotchas are.  
Roy Huggins: Yeah, that's true. Yeah. Well, that's most of what I was gonna say, Rob. Jeez.  
Rob Reinhardt: Again, you're gonna get into a lot more detail about it in a future episode.  
Roy Huggins: Yeah I actually have more [crosstalk 00:20:09]. Especially when you're talking about communication software. Like, Telemental Health software. Yeah, I gotta lot more to say about that. [crosstalk 00:20:16]. Yeah.  
Rob Reinhardt: Exactly, there's different ins and outs, depending on exactly, which piece of software we're talking about.  
Roy Huggins: Right, right. Okay, so scheduling. Scheduling actually is a pretty big thing for a lotta people, so it's worth some time. But, what else we got? What other features are we looking for, and trying to understand how we need them.  
Rob Reinhardt: Yeah so, the shortest section is, you know, when we're clients, you wanna look at ... They're probably all gonna track the name of the client, the address, that sort of thing. But then you wanna look at, how does it track contacts for that client. So, a lot of people are working ... First of all, you wanna be able to track an emergency contact for that client. People working with families are gonna wanna track ancillary contacts. "Hey, you know, I'm working with this adolescent, I need you to have the mom and the dad in there." If it's a blended family situation, mom and dad are separated or divorced; is there a way for me to not that. Who gets the appointment reminders? Is there a way to send the appointment reminders to the parent, as opposed to the 13 year old?  
Roy Huggins: Who has access to the Client Portal? Would be a really big one when you're working with minors. Like, whether or not the parents have access.  
Rob Reinhardt: Right, exactly. Yeah.  
Roy Huggins: Yeah.  
Rob Reinhardt: That's probably a whole episode, dealing with family situations.  
Roy Huggins: Yes.  
Rob Reinhardt: You know, some other things ... Some systems allow you to track custom data. A lot of 'em do not, interestingly enough. But some will allow you to create your own fields, if you have some specific data that they don't track already. Here's an interesting one, that still boggles my mind. Actually less of the systems do this, than ones that do; and that's tracking referrals.  
Roy Huggins: Oh yeah.  
Rob Reinhardt: That's a pretty big deal for us, to be able to note, "Hey, where did this client come from?" And actually, most of the systems don't allow for that. They're starting to come around; more and more of 'em are starting to add that. But I've just been shocked over the years to see how few of them have that as just a standard, ready to go feature; 'cause that's a huge deal for us.  
Roy Huggins: Well, for the Practice Management System executives who are listening to this right now; I should say, that we've had many people ask us at Person-Centered Tech's office hours about Customer Management Systems. CMSes; is that ...  
Rob Reinhardt: Yes. That's correct.  
Roy Huggins: Like, that's what is stand for right? Yeah. No, like a lotta people ask us about that, 'cause they wanna track how people are finding them, and where they're referred from; and they wanna do all that tracking. But most of those systems that do that, 'cause they're designed for marketing and sales people, they're not designed for healthcare. They're not HIPAA secure; they don't have what they need for HIPAA. So, people get frustrated because they don't have a system that can track this basic stuff for them. That would be really helpful to their business or their practice. So, for the Practice Management System's executives listening right now, a few simple CMS features would certainly be appreciated by certainly, I can tell you, quite a few members of Person-Centered Tech's office hours audience.  
Rob Reinhardt: Exactly. Yeah, I mean, that's a big deal. 'Cause even when you look on our forum, and what people are talking about; a lot of people talk about, "Hey, how are you getting your clients?" And, "What's the best way to track them?" Especially when you're early on, but even beyond that, you wanna be able to track how your marketing efforts are panning out.  
Roy Huggins: Yeah, absolutely.  
Rob Reinhardt: Are they working, or are they not working? And the best way to do that is to ask your clients how they heard about you.  
Roy Huggins: Exactly. And I hope everyone does that, by the way. And we're getting a little off topic, but I hope everyone has some way of trying to get that info from the client; like, how they found you. That's gold information.  
Rob Reinhardt: Even if you're just tracking it into a spreadsheet.  
Roy Huggins: Yeah.  
Rob Reinhardt: Find a way to keep track of that, because you're gonna be able to figure out what's working for you, from that information.  
Roy Huggins: Yup. Absolutely. Okay, back on track. What else, what else we got besides tracking client information.  
Rob Reinhardt: Yeah, and it's important to note again, kinda like our first episode, this is a survey. They're certainly depending on your practice. There's probably some very specific details you might be looking for in each of these sections that we're not covering. But it would be impossible for us to cover everything.  
Roy Huggins: Right.  
Rob Reinhardt: You know, once you've scheduled a client, and you've gotten them in there, and you've collected their information. You probably do a session with them; you're probably gonna want them to pay you.  
Roy Huggins: What? Yeah okay, sure Rob.  
Rob Reinhardt: I mean, I'm sure there's somebody out there who's running on profit, or is independently wealthy and you give back to the community by giving free sessions. I think that's awesome, but most of us, you know, are makin' a living here. So, we need to have some way to handle billing. So, you're gonna want to look at your billing features. And again, you're gonna want to base this on how your practice is structured.  
Do you deal with insurance? Are you just a private pay? Do you collect money up front? Do you send invoices out? Do you want to deal with credit cards? If so, do you want people to be able to store cards on file with you? So, these are the kind of features that you're looking for in billing.  
Roy Huggins: Right. And one thing I wanna say about that is, do not keep copies of client credit cards in your own file cabinet, or on your own computer. I know a lot of people used to do that; I don't know how many people are still doing that, since I published about that. There's a different regulation for people to take credit cards called PCIDSS. And you definitely cannot be PCIDSS compliant by keeping copies of a person's credit card info in your own stuff; you won't be able to do it. And that's a nice thing about Practice Management Systems that will store credit cards for you; is that they're doing it in a manner that's compliant with PCIDSS. So, they help you be compliant with a lotta different regulations that way.  
Rob Reinhardt: Yeah, and that's one of the two things, when people ask me, "Hey, is it worth paying ... You know, the merchant fees are usually just a little bit higher in the EHRs, though they're often comparable with something like Square. And people ask, you know, is it worth doing that; paying these slightly higher merchant fees. And the two things you benefit from; one, you don't have to worry about PCI compliance, the vendor's taken care of that. But also, the convenience of having that card on file, and now you've finished the session and you're done. You don't have to say, "Okay now, I need to collect your payment." You just ... the client walks out the door, and it's taken care of.  
Roy Huggins: Yeah, you just go bill it. Yeah, that's pretty handy. It's also handy for no-shows. If you have a no-show policy.  
Rob Reinhardt: Yup. Mm-hmm (affirmative). Exactly.  
Roy Huggins: Alright so, what else? What else we got?  
Rob Reinhardt: You've scheduled the client, you've had a session with the client, you've collected money hopefully. I certainly encourage people to collect co-pays or any other money that's due up front. But other people do the invoicing. Now you've gotta do some documentation.  
Roy Huggins: What?  
Rob Reinhardt: Yeah, I mean, I'm pretty sure most of us are required by ethics to do at least some level of documentation.  
Roy Huggins: I guess, maybe some laws as well. Okay, sure.  
Rob Reinhardt: Right. And if you're dealing with insurance, you certainly want to have some documentation. So, you wanna look at, "How do I wanna do my treatment plans and progress notes." Now some people may say, "Well, I've been doing this on paper, and I wanna find a system that translates pretty much ... you know, close to how I've been doing it on paper." Other people have told me, "You know, I'm looking at this as an opportunity to see if there's a more efficient way to do my notes ...  
Roy Huggins: Right.  
Rob Reinhardt: ... as I transfer to an electronic system." Regardless of your approach, you wanna look for a system that is going to work for you. Some systems are really quick and efficient, but maybe you can't customize the notes. Other systems provide the ability for you to customize the notes however you like; but they may be missing some other functionality that you want. So, this is a really important area where people need to go in to the trial accounts and toy around with the notes, and make sure they're gonna work for them.  
Roy Huggins: Yeah, definitely take advantage of those trial accounts; so you can go check this out. I mean, this actually feels like an area we could talk a lot about. I'd be great if there was somebody out there who like specializes in talking about documentation. You know, who might be able to help us with this.  
Rob Reinhardt: I know. Wouldn't that be amazing.  
Roy Huggins: That'd be great.  
Rob Reinhardt: Oh wait.  
Roy Huggins: Oh, there's someone at the door.  
Rob Reinhardt: Oh, lets go see who it is.  
Roy Huggins: Okay. Oh, it's Maelisa Hall. Oh my god, she knows everything about documentation. That's [crosstalk 00:28:04].  
Rob Reinhardt: She must have heard us talking.  
Roy Huggins: She must have heard us talking. Okay. Well hey, we'll let Maelisa tell us a little bit more about documentation and EHR.  
This episode of Therapy Tech with Rob and Roy is brought to you by Therapy Appointment. You provide the therapy, we'll provide the rest. One thing I like about Therapy Appointment, is the number of mental health professionals in the executive team. At Person-Centered Tech, we found that tends to translate to better features for mental health professionals, and better responsiveness to our needs. How 'bout you Rob?  
Rob Reinhardt: Yeah, Therapy Appointment is one of the EHRs that are focused on mental health professionals that has been around the longest. They were one of the first with a Client Portal; so I'm very interested to see what they do with their latest update.  
Roy Huggins: Right. Well, check 'em out at and you can use a special coupon code: ROYROB to get-  
Rob Reinhardt: Or ROBROY.  
Roy Huggins: Uh, well now, you want ROYROB for that one dollar setup fee, and the first month free; if you use: ROYROB  
Rob Reinhardt: Or ROBROY.  
So, we're happy to have with us here today, the creator of QA Prep and documentation diva Maelisa Hall. Maelisa has an extensive background in doing proper documentation that makes the insurance companies and HIPAA happy. Thank you for joining us Maelisa.  
Maelisa Hall: Thank you, I'm happy to be here.  
Roy Huggins: I'm a little intimidated to be in the presence of a diva. I'm sorry, I might not talk as much this time.  
Maelisa Hall: I'm sure you'll recover.  
Roy Huggins: Okay, thank you.  
Rob Reinhardt: We've been talking a good bit about EHR today, Maelisa. And all the innovations that they're coming out with, new features; it's still a growing market. I'm curious, what features you're seeing that you are really excited about, that you think are really beneficial.  
Maelisa Hall: Yeah. So, like you said, there's a lot coming out. One of the biggest ones that I enjoy seeing, and that a lot of therapists enjoy is customizability. I don't know if I just made up a word or not. But, you know, being able to customize different things within the EHR. So, whether that's being able to create your own template, and to the extent of being able to create your own drop down menus, as well as having pretext fields; being able to put in your own forms. And, I know like even for myself, with my own EHR, it's really nice that I can customize my forms a lot, and have different sections for people to sign in different places. So, if I wanna have, inside one form, really high light, a certain section. So, those things, I think, have been huge.  
And then, another thing that a lot of EHRs already have, but I think even more are adding on, or they're adding different features within this; is having a Client Portal. So, it's not just your file, but it's actually a communication center between you and the client, right. So, it's taking it a little bit extra. And, I like that a lot because it lets clients come in, view things like your forms and your paperwork, and complete things ahead of time. And it's able to save therapists a lot of time on their documentation. And a lot of headache with figuring out how to do secure emails; if you can just tell a client, log in and sign this form, you don't have to worry about sending things back and forth, or if they can just log in and download a form. You're not having to do that, so, I mean, it just makes things so much easier.  
Rob Reinhardt: Well plus, if you've got those communications already in the system, you don't have this copy and paste [inaudible 00:31:30] communications that you have to deal with.  
Maelisa Hall: Yes, exactly.  
Rob Reinhardt: And you are totally welcome to make up words, this is a tech geek show. [inaudible 00:31:41] I think customizability is surely a word, and if it isn't, it is now.  
Roy Huggins: I think that is a word, yeah. That one is actually is already a word, that's okay. So, now you have to make up another one, Maelisa.  
Maelisa Hall: Alright, hopefully I can in the next five minutes or so.  
Roy Huggins: Right, get on it.  
Rob Reinhardt: [crosstalk 00:31:54] filled your made up word quota, for the show yet. So, you talked about the Client Portal. And one of the cools things is being able to have clients complete paperwork online, and that's really convenient and efficient. I know a lot of systems, they let you customize that. Customizability; and create the pull downs and check boxes like you were talking about.  
Roy Huggins: You just made up a word.  
Rob Reinhardt: Yes, I'm just making up words 'cause my brain is goin' faster than my mouth. So, do you have any guidance for therapists, when they have the opportunity to create their own assessments, paperwork online.  
Maelisa Hall: Yeah, as far as like, ways to maximize that. I think the first thing that I recommend to people; that a lot of people have actually implemented, have said it's been a game changer for them, is to use that Client Portal ... However much you're able to customize your forms ... To have clients fill out as much paperwork ahead of time as possible. One of the benefits to that is obviously you save time, because you don't have to sit there and actually do a bunch of the paperwork with clients in the office. You're gonna review it with them, in your first session. But, you have a really good baseline already set. But the other thing is, you get to see how the client describe things in their own words. So, that's one of the benefits I like of having people fill out paperwork ahead of time. So, instead of me asking them about, why it is they came to see me, or what goals they would like to see accomplished in therapy.  
I'm actually seeing what they wrote down. And I've noticed that a lot of times people will write, this is in my practice, people will end up writing something that's a little more different or a lot more in depth than what we talked about on the phone; in that consultation call. So, it gives me a lot more information. I like being able to then ... you know, I already have ... 'cause most people aren't coming to you saying, "I'm depressed." Right. Some people do, but a lot of people are using other words to describe how they're feeling or what's going on. So, then I'm able to pull out their own words, outta those forms, and use that in our communication together. So, it's helping with a lot of things, right. It's making things easier, it's saving me time; but then it's also helping to build rapport a little bit more quickly, and giving you a better clinical idea of what's going on.  
And then I would say, not everybody does that, right. So, as awesome as technology is, and as much as we try to get people to use it; sometimes, they just don't. And they show up, and they haven't done any of the paperwork, and you have to do it with them still. And that's always gonna happen. So, making sure that you try and do your assessments in that first session, in person. So, I know a lot of people will tell me, "Oh, well I like to write, and take notes." And so then they take notes, and end up spending an hour afterwards typing in their assessment because they're not using paper forms. They feel like their assessment needs to be in the EHR; but now they have all this handwritten stuff. So, either scan it in; you know, and don't waste your time. If you have like a full quantity you just did on paper, scan it in. That should always be an option in your EHR.  
Or, use the computer, and type it with people there. And I know a lot of times, therapists are a little bit wary of doing that. 'Cause they're like, "Well, what about building rapport. And I don't wanna feel disconnected." So, you definitely don't wanna be looking down at the keys, you know, the keyboard; and not paying attention to them. But it's just like you would tell any other client, right. It's about communication, so I'll tell people, "Oh, hold on a second. Lemme finish typing that up, I wanna make sure I get this down." I'm letting people know if I need extra time to finish typing something out. And then I'm also letting people know; at the end, I'll always go through my forms again and say, "Lemme just double check and make sure I covered anything; we didn't miss anything." And I've never had it feel like it impaired our discussion in any way. So, I would say ... It's also something people are getting really used to, like in the doctor's office and stuff. It can be such a big game changer for therapists, because if you're trying to type all that in afterwards, it just takes way too much time; for so many people. So, that would be my biggest piece of advice.  
Roy Huggins: I love the idea of you advising us towards less time spent doing documentation. That's pretty awesome.  
Rob Reinhardt: Yeah, and I think that's a great tip that if you involve your client in the process; let them know what you're doing, why it's important. Then it's not gonna feel like you're not paying attention to them.  
Maelisa Hall: Exactly. And it makes everything, I mean, my big thing is meaningful documentation; that's the phrase I use a lot. And that's the whole point right. Documentation is not supposed to be some random form that you fill out just because; it's supposed to have a purpose. And so, if you're involving your client, and using it in your sessions a little bit more, it does tend to make it more meaningful. And I can tell you as somebody who's reviewed a lot of people's charts, and files, etc.; that I can tell when people have waited to do paperwork. Because it's much more complete, it makes so much more sense [inaudible 00:36:56] when people do it either like in session, or right away.  
Roy Huggins: Right, right, yeah. Maelisa, can I invite you to come talk to my students please. Can you just fly out to Portland real quick.  
Maelisa Hall: Sure, yeah. Buy me a ticket, I'm up there.  
Roy Huggins: I knew there was a catch.  
Rob Reinhardt: Are you ready for the surprise question Maelisa?  
Maelisa Hall: I am. Let's do it.  
Rob Reinhardt: Describe comes with over a dozen activities that can be used with clients of all ages. Find out more and ...  
Alright, so this is our semi-random question from the describe deck. Today's word is creative. Tell us, in what ways are you creative?  
Maelisa Hall: Oh, I am creative in a lot of ways I think, actually. Not in all ways, but I think I'm creative in the way that I can look at different problems. So, that's one thing that I have found has been really helpful; with QA Prep, with grading trainings, doing trainings. Also in my clinical work, and also just talking with people. So, a lot of times I will be the person that's thinking outside the box about the solution; and thinking about, "Well, why does it have to be A or B, what about C, D, and E. Let's look at all these other things." So, I would say that's probably the biggest way in which I'm creative. Although I am kind of artistic and like drama, and the arts, and all that kind of stuff too.  
Roy Huggins: Wait, drama like thespian drama. Not like interpersonal drama.  
Maelisa Hall: Yeah, yeah.  
Roy Huggins: Yeah, okay. Great.  
Maelisa Hall: Yeah, yeah, yeah.  
[00:38:27] Rob Reinhardt:   you took high school drama.  
Roy Huggins: That's why I'm a counselor.  
Rob Reinhardt: Exactly.  
Roy Huggins: [inaudible 00:38:33] Rob.  
Maelisa Hall: Yeah not the typical diva type drama.  
Roy Huggins: Oh, I see. There you go.  
Rob Reinhardt: So, you're moonlighting in community theater?  
Maelisa Hall: No, I have thought about trying out for different things here and there. But, right now, I don't have the time to do it. I'm learning how to sail instead. You can only have so many hobbies when you have two businesses.  
Rob Reinhardt: Oh.  
Roy Huggins: Yeah. Excellent.  
Rob Reinhardt: And you talked about how you helped people at QA Prep. Can you tell us a little bit more about that? I know you offer help in guidance and creating excellent and meaningful documentation.  
Maelisa Hall: Yeah, you can head over to and I have a ton of resources there on the blog. You can find all kinds of free information. I also have a free crash course people can sign up for. And so, in the crash course I go through little three to four minute videos on administrative paperwork, notes, treatment planning, assessment ... So giving you some quick tips you can use. And I also have some sample notes, and a sample treatment plan in there people can check out. And then, if you are specifically looking for help with assessment stuff, and your paperwork in general we were talking about. I do sell a paperwork packet too; but I always encourage people to check out the crash course first. You can get to know me a little bit more through those videos, and if you like that, you might like some of the stuff that you can buy from me.  
Roy Huggins: I think you should buy Maelisa's paperwork packet.  
Rob Reinhardt: I can tell you, you know, from all the people who come to me to talk about EHR, and they say, "Well, how do I make sure my paperwork's okay?" I tell them, "You need to head over to QA Prep, there's quality stuff there to help you out with that."  
Roy Huggins: And I gotta say, I got to see Maelisa present at the ACA conference this year. And it was on how to document for insurance; and it was fantastic. I mean, there's a lot of ... Maelisa's really good at helping us understand what you need to do; including a lot of things that are not conventional wisdom. You know, there's a lot of conventional wisdom that people tell you that seems to go against what Maelisa is saying; but honestly, everyone should check that out. If you document for insurance; Maelisa knows how to make it make sense, and work for you. And not be overwhelming. So, you definitely wanna check that out.  
Maelisa Hall: Thank you.  
Rob Reinhardt: Yeah, and thank you for joining us today, Maelisa.  
Maelisa Hall: Yeah. Thank you guys for sharing this. I know a lot of questions on EHR, so I'm really happy to give this extra resource to people because there's way too many things out there to remember all of it, and keep track of everything that's goin' on.  
Rob Reinhardt: I know that all too well.  
Roy Huggins: No kidding. Alright, thanks Maelisa. It was good seeing you.  
Maelisa Hall: Thanks.  
Rob Reinhardt: Wow, that was really helpful. I'm very glad that Maelisa could join us today and talk about how to do your progress notes, and related a bit to EHR.  
Roy Huggins: Yeah. It's really great. Every time I get to hear her talk, it's fantastic. I actually got to see her at the ACA Conference in 2016; and she had a whole thing about just documenting so that insurance companies will like your documentation. That was really useful. And I know Rob, that's actually something you're really good at, is using these systems to file insurance billing. How do these systems help. I mean, are they able to really help do that? Make it easier for you?  
Rob Reinhardt: Yeah honestly, if a practice is dealing with insurance filing ... This is another huge area where they can get an excellent turn on investment. You're talking about having everything well integrated. So, in the olden days, you were either doing paper claims. And then we kinda transferred to a situation where maybe you log in to each insurance website and file claims electronically; or you had hire a third party biller. Now we have these integrated systems, where the client data is already in the system. And by the time you create a progress note, everything is already in the system that's necessary for the claim, from the diagnosis to the CPT Code, to the client demographic information. So, once you've completed a session in the note, you're a couple of clicks away from having the insurance claim filed. You don't have fill anything out, sign anything. You just click a couple buttons. Boom. The claim's already sent off to the insurance company.  
And then, when you get into things like integrated ERAs. So, ERA is electronic remittance advice. It's the electronic equivalent of the EOG that we're used to getting. Those paper forms that say, "Here's what the insurance will pay, and what the client has to pay. Well, an ERA comes back into your system, and says, "Hey, here's what the insurance paid. And here's the client, and the date of the session. Click this button and it will apply that payment for you.  
Roy Huggins: Wow, that's pretty handy.  
Rob Reinhardt: You no longer have to receive this paper EOB, and then manually enter it. And then what are you going to do with the paper EOB, and all that fun stuff. So, this is another area, especially for clinicians or groups that are dealing with insurance; a huge time saver and return on investment.  
Roy Huggins: And, I really love when you talk about this feature, because it's so powerful. Given like the kinds of pain in the butt that people go through to deal with insurance. And it's amazing, and then, for someone like me who doesn't bill insurance; it's completely useless.  
Rob Reinhardt: Well, it depends. There's a couple ways to deal with not taking insurance. One is, "Hey, I don't deal with it at all."  
Roy Huggins: Right.  
Rob Reinhardt: Another is, "Well, I don't take insurance. But I'll also provide you a super bill, so that you can file your own claim with insurance. A lot of these systems will let you provide that to your clients. And then, there's two ways you can handle being an out-of-network provider while also providing some convenience for your clients. One is, "Hey, you pay me up front. I will file an electronic claim for you." Don't accept assignment; and the insurance company will pay the client anything they're due. So, you're still getting your money up front, you're not necessarily having to deal with the headaches of the insurance; but you provide this extra convenience for the client.  
Roy Huggins: Right. Yeah. Yeah, that's true.  
Rob Reinhardt: And then there are still some people who do accept assignment. Which means, you're accepting what the insurance company will pay you. They're paying you after you file the out-of-network claim with them; and you can always collect the balance from the client.  
Roy Huggins: Right. I should not that, certainly here in Oregon, Blue Cross is no longer allowing the clinician to no longer accept assignment. So, even like, when my clients go take my super bill and file with Blue Cross, they send the checks to me. Even though the super bill says they've already paid, and all that. So, I don't know if that's gonna spread. But, that's an interesting thing happening over here.  
Rob Reinhardt: Yeah, that is very interesting.  
Roy Huggins: Yeah. But yeah, so, you know, insurance companies are always changing things around.  
Rob Reinhardt: Exactly.  
Roy Huggins: Speaking of super bills; one thing that could get me going on using a Practice Management System, could be the ability to easily get super bills to my clients through a Client Portal, right. And we talk about Client Portals a lot.  
Rob Reinhardt: The other thing for people to look at is, how the Client Portal integrates or does not with your own website.  
Roy Huggins: Yeah. It's really nice when it does.  
Rob Reinhardt: Yeah, so some of them will just provide you a link that you have to post on your website. And your clients or potential clients will click that button or link, and it leads you to this external site. A couple of them have something where you can actually integrate it within your website, so they don't navigate to a separate address. So, that's something that's important to some people; you wanna look at, "Hey, what is it gonna look like for the client?"  
Roy Huggins: Right. Yeah so, it's cool ... I think we talked about this in Episode One as well. A cool thing about these things can be that, if it integrates well, or even if they just give you a button that goes to a page that they set up; even if that page is set up in a way that's very friendly for clients, it can make a really good flow for people who come to your site, discover you and then easily find how to go then make contact with you. 'Cause then they can go to that page and be like, "I'm gonna schedule that consult, or that first session."  
Rob Reinhardt: Exactly. You want it to be user friendly for, not just your current clients, but potential clients; you don't want that to be a barrier to new people signing up. The whole point of that is to provide a convenience, and actually boost your people signing up for your services.  
Roy Huggins: Yeah exactly. And I'll tell you, another thing ... Sorry, I'm moving down the list here ... Another thing that excites me about Client Portals, is when they have the ability to do secure messaging with clients. You know, where you can communicate with them, in a way that's secure. And some of them have that, some of them don't. But I especially love it, when in addition to that, the Practice Management System also has a smartphone app. Or some kind of useful ... something that makes it easy for me and client to get to the Client Portal. And we could even use it as a much more convenient way for us to textually communicate with each other. You know, send the client a super bill and all those kinds of things. Then we can do it right in our smartphone. I think that tends to increase the client's engagement with, something I see as very important, which is the secure ways to communicate with their therapist.  
Rob Reinhardt: One thing to note about the mobile apps. Most of the ones that do have a mobile app, are gonna have more limited functionality. In other words, they want it streamlined. You're not gonna be able to go and do all your billing functionality for example in these mobile apps. You're gonna usually get the core functionality you're most likely to use from a mobile app; like the scheduling, and maybe having a quick look at a note. And then maybe some core functionality for the clients as well.  
Roy Huggins: Yeah, yeah. That's usually what it is. It's nice when they build the app to make interaction between the clinician and the client more efficient; I love that.  
Rob Reinhardt: Right, and again, that's why I think we're kinda entering the golden age ... we're gonna see more and more of those extra refined awesome features coming in the next couple years. 'Cause most of these systems have got the basics down and now we're gonna start to see the really big bang for your buck features coming out.  
Roy Huggins: I think so too. Yeah, it'll be great. Okay, so Rob, there's a complaint that we sometimes get from people who talk about Practice Management System saying they're clunky. That's a word people will use sometimes. And people will have told us that they occasionally will find something clunky enough that they just can't use it. What's the clunk factor across the board with Practice Management Systems.  
Rob Reinhardt: Yeah, it varies widely. There's some systems that have been here for years and really haven't had an update. And so, you can tell they're from 10, 15 years ago. There are other ones that are more modern. And it's interesting because of how the gamut of people looking for different things. So, I've had people that say, "You know, I don't care if it's got a big learning curve and is a little clunky, as long as it's got all the features I want." And I've had other people say, "Well, you know, I'm willing to sacrifice a couple features, as long as it's easy to use and pretty to look at."  
Roy Huggins: Right.  
Rob Reinhardt: So, that's another area that you need to factor for yourself. You know, "What's my preference? Do I want all the features, no matter how easy it is to use? Or do I want it to be very easy to use, easy to find my way around the application. And if that means I have to drop a couple features, that's fine." And then of course, lots of people fall in between those two extremes.  
Roy Huggins: Right. And sometimes people will underestimate the importance of the usability, until you get in there and have to do it every time you have a system. It can be as little as just how a drop down menu works, can make a big difference.  
Rob Reinhardt: Yeah, and that's another reason to get in there and use the free trial.  
Roy Huggins: Exactly.  
Rob Reinhardt: And do use some of those basic functions; the scheduling and the note taking. Those are the core functions you're gonna spend most of your time doing. So, make sure you get in there and see what that's gonna look like.  
Roy Huggins: Absolutely.  
Rob Reinhardt: And probably on a more minor tip these days; sometimes your operating system can matter. If it's a browser based system, it isn't really going to matter much. 'Cause you'll be able to access the system from any web browser. So, by browser based, I mean, you get to this EHR, by going to an address in your web browser. So, those systems are pretty OS independent. There are a handful of systems out there however, that are more remote access applications. That means you have to install an applet on your actual desktop or laptop, and access the system that way. Those are sometimes not as friendly to use on every operating system, and certainly can be more problematic on mobile devices.  
Roy Huggins: Right.  
Rob Reinhardt: Because those systems tend to not be built in such a way to be friendly on a smaller screen.  
Roy Huggins: Most Practice Management Systems I've seen are browser based.  
Rob Reinhardt: Yeah, and even a lot of the ones that are not browser based, are moving in that direction, because they know that's where they need to be.  
Roy Huggins: Right. That makes sense.  
Rob Reinhardt: And the ones that aren't moving in that direction, are generally target for larger practices.  
Roy Huggins: Yeah, like Epic doesn't work through web browser, I believe.  
Rob Reinhardt: Yeah, when we talk about Epic, we're talking about very large systems, very expensive systems-  
Roy Huggins: Like whole hospitals.  
Rob Reinhardt: ... Most of the people in our field are not going to be working with ...  
Roy Huggins: Well, they might work with Epic, but not on their own dime. It's on someone else's dollar.  
Rob Reinhardt: Right.  
Roy Huggins: Okay, well speaking of big systems. Okay, but a smaller scale ... you got a group practice. You said in Episode One, and you said in this episode about like how we need the Practice Management System to grow with your practice. What are some examples of what that means concretely  
Rob Reinhardt: Yeah. So, there's some special considerations with groups. It's not just the scalability, you know, we talked about in the scheduling are. Now you've got four or five clinicians on the same schedule; so you wanna look at, can I view all their schedules side by side? So, you know, if I'm looking for an open appointment for a new client. Or maybe I have a billing or an administrative staff person, who's needing to look at the schedule of all five of my clinicians at once. Are they gonna be able to do that? Are they gonna be able to do that, in a user friendly manner? Are they able to search for open sessions based on criteria?  
Roy Huggins: Right.  
Rob Reinhardt: And then you get into, now we've got more than one person in the system. What can everybody see? Are you able to set permission structures within the system, so that clinicians, for example, can only see their own client's records.  
Roy Huggins: Right.  
Rob Reinhardt: Can you allow an administrative staff person to have functionality like scheduling, collecting payments without seeing client records.  
Roy Huggins: Right.  
Rob Reinhardt: By client records, I mean the clinical record. So, being able to go in there and make sure people can see what they need to see to carry out their functionality; without seeing things they don't necessarily need to have permission to see.  
Roy Huggins: And here's a little hint of course. Everything Rob just mentioned is also essential for your HIPAA compliance.  
Rob Reinhardt: Exactly.  
Roy Huggins: Yeah. Alright cool. So, I mean, that was a pretty good survey of what we do with these systems, and what to look for in them, Rob. You talked a little bit about the idea of thinking about where you wanna go in five years. Anything else you wanna say about how people choose the right system?  
Rob Reinhardt: Well, I talked about not starting with asking others about their experiences. I do think that needs to be part of the puzzle; but I think it should be third or fourth down the list, after you've looked at the features you want. You know, looked at all the things we've talked about today, prioritized what's most important to you, narrowed things down to a couple, and done some free trials; then you might talk to some people about, "Hey, what was your experience with this app?" And then it's even more helpful. 'Cause now you're just, "Hey, these are the two or three I'm looking at. I only have to get feedback on these two or three; as opposed to, going on a forum and saying, "Hey, what's the best EHR?" And getting 15 different answers.  
Roy Huggins: Right. Yeah, I like that a lot. When you're like, "Okay, I know that these will do what I need. Okay guys, tell me your experiences with them." Yeah, that would work a lot better.  
Rob Reinhardt: Yeah, and that lets you to the finely grained stuff. "Okay, I know a lot about these systems now, 'cause I've done some research and some free trials. Who can tell me how easy it is to use this specific feature, in this EHR. And have you had any issues with this EHR in the scheduling realm." Or, "I notice in the free trial I can't do this. Am I missing something?"  
Roy Huggins: Right. And for some people, it might be like, "How's the customer service? Are they really responsive when I don't know how to use something?"  
Rob Reinhardt: Exactly. That was gonna be the next thing I said, was it also gives you an opportunity to ask them about customer service. But as you're doing the free trials, make sure you come up with some questions. Even if it seems like a great system, come up with some questions to ask their customer service department so you can see how responsive they are.  
Roy Huggins: Right. Yeah. And different people need different kinds of responsiveness. You know, some people need it for like, "I can't figure out how to do this thing. Can you help me?" Versus, you know, a more advanced question. You know, like, different people will be at different levels. And so, that itself might mean the difference between somebody using system A, or somebody using system B; just their level of tech savvy, and how good their support is.  
Rob Reinhardt: Right, or their form of support. I know some systems, and this is pretty common in the tech world in general. But some systems only provide email or chat support.  
Roy Huggins: Right.  
Rob Reinhardt: Whereas others will provide phone support. So, if that's important to you, that's certainly something you wanna examine as well.  
Roy Huggins: Right. Yeah, exactly. So great, anything else you wanna say about EHR systems before we sign off, Rob?  
Rob Reinhardt: I just think, you know, the important pieces are that I think most people will get a solid return on investment. I don't think everybody has to use an EHR. But I think, most people, especially if you're gonna be in business long term, are gonna get a solid return on investment. Make sure you do some research first. It's not impossible, but it's certainly a challenge to move from one system to another. So, you wanna choose one that's gonna last a while, when you make your choice.  
Roy Huggins: Yeah, and I'll throw in my last thing. As a person who doesn't use a Practice Management System, I still keep records on paper ... yes we joke about that, but I do keep records ... I do keep them, every session, every client; for my licensing board people who are listening. No. 'Cause I don't use these systems, I do things pretty piecemeal. And, you know, all these features, can be accomplished through individual pieces of software as well. And so that's another option. You know, just making sure people know that you don't have to go get a Practice Management System. But certainly, it's worth having a whole episode just about the systems, because so many people will find that more convenient than the piecemeal thing that I do.  
Rob Reinhardt: Right again, it goes back to finding what works for your particular practice.  
Roy Huggins: Right, okay. Well, Rob, it looks like we're coming up to the end of our Therapy Tech hour. Should we wrap it up?  
Rob Reinhardt: I guess so, it's always so sad when we have to finish, Roy.  
Roy Huggins: I know. Yeah, we love talking about this stuff, and we love helping everybody. But we'll have many more in the future, we'll come back.  
Rob Reinhardt: Alright. I look forward to it.  
Roy Huggins: Me too. I'll see you next time.  
Rob Reinhardt: Thank you for tuning in to Therapy Tech with Rob and Roy. This episode has been sponsored by Therapy Appointment. You provide the therapy, we provide the rest. Find out more at ... Episode notes and helpful resources can be found at ... Until next time, may your technology be secure, and your heart be free.  

Title photo by Samuel Zeller on Unsplash

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