Starting a Counseling Practice Part 6: Do you need an EHR

Before you start researching all the different Electronic Health Record (EHR) options out there, how do you know you need an EHR and how do you choose?

VISION: Think about what a better private practice looks like and what it means for you to have balance. Look at a typical day and how your time and energy is spent. An EHR can have a learning curve but in the long run, it is meant to save you time and money.

CREATE: Don’t recreate what doesn’t work for you currently. Start with what would fee great for you and your clients. Look at your current processes, what irritates you? What do you love? For example, if you have a long intake form that you have clients fill out before session, don’t continue that process and then add scanning it into your EHR. Create the intake form in your EHR so clients don’t have to come in early to fill out paperwork and you don’t have to deal with scanning. Or maybe you have several forms. Now that you are considering an EHR, look at creating one form, to simplify the process.  Another tip for this part – when you move into an EHR, just move over the current clients you are seeing. Start there, learn the system, create efficient processes and then deal with transferring old records. Don’t drink out of the fire hydrant with a dixie cup.

ENGAGE – Using an electronic health record can actually engage your client. Show them that you value their time. Portal access to message you, complete forms or sign a release of information makes the process easy for them, reduces their anxiety and thus can increase their commitment as you remove barriers. When you take charge of your initial assessment time to be about building the relationship and not about completing intake paperwork, that is way more engaging for a client.

VALUE – Value your time and the time of your clients.  When you use reminders for appointments, it can reduce no shows. When you keep a credit card on file and charge for no-shows, you will see a significant drop in those happening as well. Also when they can do paperwork in their own private space on their own time, you are giving them more flexibility and valuing the space they need to be thorough and thoughtful in completing the documentation.

BOUNDARIES – Going paperless means whatever you decide it means. But if you are going to go paperless consider how it will help with boundaries around the use of your time and energy. You can have an EHR and still control your calendar, but the automated reminders via text or email make it clear to clients when they are expected to be in the office. You have to follow through on the processes you create. If you are reducing no-shows, keep a credit card on file and a client still has a no-show, then you need to follow through on the policies that you have in place. It’s not only good business, but it is a clinical decision as well.

AUTOMATE – Automate whenever possible. You are a therapists not an administrative assistant. Computers were developed to save us time, they really haven’t. Why? We don’t use them well. Sometimes having an assistant just isn’t feasible, or just doesn’t make sense when it is something that could be automated.   Automation also respects my client’s privacy. Let’s discuss an example. What happens if a client needs you to sign a release form and it is urgent? E-signatures and forms ready to go online means that clients take the initiative to sign online and I get it immediately. No faxing back and forth, or leaving envelopes, mailing, lost forms, etc.  Time saving, liability reducing, client centered!

SUSTAIN – Do increase income by reducing or eliminating lost revenue for no-shows and late cancellations for ongoing clients. Businesses who accept credit cards see on average a 23% increase in income in the first year- integrating credit cards during this process could help your bottom line.  Allow this to be a time that you assess and revise business practices including late cancellation fee and how you will set that boundary. If you are na Out of network provider for PPO plans, make sure your EHR provides a CMS-1500 option as it will improve reimbursement to your clients which will allow them to stay with you as long as they need.    Do you love insurance? Choose a plan that integrates electronic billing or an administrative feature that your biller can log-in and just get the information they need.  Do you want to get away from insurance? A paperless office can make that easier as well! I love being able to pull up easy statistics about my income comparisons year by year, and comparing gross income month by month. It helps me to think about my business as a BUSINESS.

SIMPLIFY. Single entry reduces the opportunity for mistakes. Allowing your clients to enter their own details vs them telling you and you transcribing it into the system, will allow for mistake reduction as well. What does simplify look like for my practice? Client logs in, gives me their information, I look it over, write a progress note after the session, and at session 3 assign a dx (if needed), and write up my concise tx plan. I then go in and with one click can print a cms-1500 that is auto-populated with client’s information, my practice information, the fees for the session, cpt codes, diagnosis, etc. I simply print, sign, and hand to my client with an envelope and a stamp. So much easier!

SECURITY. You want an EHR with military grade encryption, security, PCI compliance, and HIPAA compliance. Your filing cabinet could be opened with a butter knife. We have an illusion of security thinking that if we physically see it, we can protect. But the reality is that with the security given in an EHR, your records are probably much safer than in your office.

It really empowers your clients process as well. “Can you just email that to me” they ask. “Sure in the portal or in an encrypted email.” I respond. “Why?” they ask. And then I have an opportunity to talk to them about respecting their privacy and the privacy of their therapy. This is important stuff that no one is telling clients about.

SERVICE – You are more helpful with less stress. It is an uplevel in service when you have an EHR. Clients will really appeciate the ease of navigating working with you. My clients have literally said this to me, they wish everyone was doing this and why can’t counselors get on board with what doctors offices and hospitals are now doing. They can download charges for their taxes and that makes their tax time easier. They can set a preference for how they are reminded about session, which makes their scheduling easier. I have time to return phone calls when other clinicians are disorganized and call back too late to book the client. This also helps when you have a professional will. You can include who will have access to your electronic health record in the case that something happens to you. This allows the transition for the covering therapist to be more smooth and easy for them and for the clients.

ASK FOR HELP – If you need help ask. If you pay for a service, it has customer service…USE THEM!!! You are paying for it already  Not sure what makes sense for your particular business? Hire a consultant. “I’ve gone through and played with dozens of programs- while it was really helpful- I wouldn’t recommend it. And to mentally keep track I had to do a crazy Excel spreadsheet- and then everything changed!

Make sure that the solution fits for you before you make the change. Just because one practice loves XYZ and the other person loves ABC, your needs that meet your vision might be different. Still not sure if going paperless is right for you? Take the Quiz! 

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Miranda Palmer

I have successfully built a cash pay psychotherapy practice from scratch on a shoestring budget. I have also failed a licensed exam by 1 point (only to have the licensing board send me a later months later saying I passed), started an online study group to ease my own isolation and have now reached thousands of therapists across the country, helped other therapists market their psychotherapy practices, and helped awesome business owners move from close to closing their doors, to being profitable in less than 6 weeks. I've failed at launching online programs. I've had wild success at launching online programs. I've made mistakes in private practice I've taught others how to avoid my mistakes. You can do this. You were called to this work. Now- go do it! Find some help or inspiration as you need it- but do the work!