How To Improve Efficiency And Cut Costs With Digital Technology

By Bruce Werber, DPM

   In these times of diminishing reimbursement, we must look at ways of decreasing the costs of our practices. Obviously, we cannot cut much from patient care costs and we have a limited ability to increase fees and income from our practices. In any business, there are ways to improve the net profit. One could implement extended hours to see more patients, minimize payroll costs by reducing staff or try to lower the cost of materials.    However, I recommend taking a closer look at technology and changing the standard workflow to improve efficiency and decrease hidden costs. Indeed, there are several technologies that reduce or eliminate a large number of repetitive tasks and bolster your bottom line.

Why It Is Time To Rethink Your Phone Service

   Most practices pay for phone service with a traditional phone company and pay a separate company for Internet service but one provider can give a practice the benefit of both. If you are already paying for a cable or DSL Internet connection, you can eliminate the traditional phone company service and just use VoIP (Voice over Internet Protocol) to provide phone service over the Internet.    With VoIP, podiatrists can use a high-speed Internet connection to make and receive phone calls at a fraction of the cost one pays for typical phone service. The reliability is improving and fairly large corporations are embracing the technology.    VoIP has been in use over the past few years by DialPad (, Net2Phone ( and Yahoo Messenger ( These services used to have two major drawbacks: needing a headset tethered to the home computer and having no local number for incoming calls.    With today’s VoIP service, one can use a standard household phone to receive incoming calls, have unlimited long distance, have voice mails sent to e-mail and more. A small adapter connects the Internet router and a standard telephone handset. With a VoIP system, users may save anywhere from $20 to hundreds a month. On top of the savings, a practice gets even more features than the standard telephone service offers. What does a practice need to reap the benefits of VoIP service?    • A high-speed Internet connection (whether it is cable or DSL).    • A standard household cord/cordless phone plugged into the broadband telephone adapter. If the office telephone system is fairly new, one can adapt it to use VoIP in most cases.    • A router that facilitates simultaneous Web usage and phone conversations. This router is usually supplied by the company which provides the VoIP service.    One can choose from provider services such as Dialpad, Go2Call (, Net2Phone, Vonage ( and iConnectHere ( just to name a few. Telephone number portability allows a practice to keep its phone numbers, port them to one of these companies and then discontinue using the traditional phone company.

Other Phone Modifications That Can Enhance Efficiency

   An answering service is a significant cost each month for many practices. A combination of call forwarding, voice mail and cell phone technologies can eliminate the cost of an answering service.    One can add voice mail to the office lines. The message can direct patients with emergencies to call a secondary number, which is call forwarded to the DPM’s cell phone. The cell phone can identify such calls with a special ring. This lets the doctor know a patient is calling and he or she can either answer immediately or let the call go to voice mail.    The advantage is one can hear the patient’s concern firsthand, not through the answering service operator’s interpretation. The call is logged on the phone and phone bill so one has documentation of receiving the message and having returned the call.    How many times has your staff interrupted you for a call that was unnecessary but didn’t disturb you for the important call? In our office, we use text messaging and instant messaging for communicating messages and information during office/work hours. Instead of putting a message on a message pad, a staff member can immediately type it online and send it to the cell phone. I can decide to act immediately on the message by sending a reply or deal with the issue later.    As far as mobile phones go, I recommend a Treo 600, the newer model Treo 650 or the Blackberry. Each of these phones has PDA functions, text messaging, instant messaging and/or e-mail. Certainly, there are other phones with text messaging capabilities but these models provide the full range of communication options.    This small change has reduced interruptions and saved countless time. It has virtually eliminated phone tag. It has allowed the staff to respond to patient problems almost instantaneously, decreasing patient complaints. This also eliminates the need for a beeper, another significant cost savings.

Streamline Your Fax System

   With the advent of several new services, a practice can eliminate the cost of an additional phone line for the fax machine. These services include, and but the most well known are and These services provide a dedicated fax number that a practice can give out. Faxes sent to that number are routed to e-mail. This eliminates the cost of a phone line, fax machine and paper cost for incoming junk faxes, which one can just delete from the e-mail inbox.    You or your staff can send faxes directly from the computer as a Word file or type them directly into the fax program. An inexpensive scanner or multifunction printer with a scanner can fax non-electronic documents such as referrals or prescriptions. One advantage of using these fax products is that one can store and save these documents electronically, eliminating unnecessary paper in the office. As more and more practices make the move to a paperless office, staff can now attach these electronic files to each patient’s record.    These fax services are reasonably priced, ranging from free to $20 per month. Even at the highest price, these services are less expensive than having a phone line, let alone the paper and time that you and your staff can save.

Archiving Records: How To Maximize Savings And Save Space

   To maintain old charts, a practice can spend $100 per month or more for storage space. We all keep explanation of benefits (EOBs) for years. Can a practice really find needed records after 12 months or even two months? How often does a practice ever need to find them again? In my experience, our office has rarely needed to retrieve these records yet we spent money every month storing them. The same goes for bills, receipts, message books and old appointment books. It is time to eliminate this drain on financial and space resources.    For a modest investment of time and money, a practice can eliminate its storage locker, regain office space and eliminate mold and mildew. This requires a high-speed scanner that can scan at least 50 pages per minute. The scanner should have automatic document feeder (ADF) and duplex scanning (allowing one to scan both sides of the page simultaneously). While these scanners typically range in price from $3,000 to $10,000, one can also find them on (using the search term “high speed paper scanners”) at a significant discount. To confirm that the scanner is of quality and has all the components the practice needs, check it out on    Connecting the scanner to the computer requires a high-speed port. Some scanners require an SCSI interface card. Kofax boards are the most common and the best of their class. You can also find these on eBay. These interface cards range from $500 to $3,000. They allow the scanner to communicate at high speed with the computer, achieving the promised 50 to 70 pages per minute scan speeds. Some scanners will use a FireWire port and some require USB2. These types of ports are now found on newer computers and are also fairly inexpensive to add to an older computer, costing between $50 to $150.    To understand how the scanner will connect to the computer, check out the Web site as well as the manufacturer’s Web site for details.    The computer required for this archiving process is a Pentium 4 class machine with a CDRW, 256 MB of RAM, USB2 and/or FireWire ports. The computer should have a very large hard drive of at least 200 GB. The operating system can be XP Home. I prefer XP Professional since it allows easier networking to the office network.

What You Should Know About Other Helpful Tools

   One should also incorporate either a Webcam with 1.3 megapixels or memory, or a digital camera with a higher megapixel count. Your staff can use this camera for copying radiographs. We have a setup that includes a view box and a Logitech orbital Webcam. We take a picture of the radiograph and store it with the patient’s name and X-ray date.    Paper management software is the last piece of the setup and two companies have very reasonably priced products. Scansoft sells Paperport for $100 to $160. Another one in the same price range is Papermaster by eFax. Both of these products are very easy to use. In setting up the program, one can create a virtual filing cabinet that contains patient charts. This makes it easy for the staff to find the old charts, invoices and EOBs very quickly.

A Guide To Simplifying Patient Records

   To simplify records, start by taking out a chart older than three years and organize the pages. Then place all of the papers in the chart in the scanner and scan them into a file with the patient’s name and date of birth. After scanning and confirming the chart info, shred it and discard the paper chart with a HIPAA-compliant waste company. Back up the hard drive daily to either a second external drive or a CD. Take the backup medium off premises.    Utilizing the services of a minimum wage administrative worker, we scanned 20,000 charts in under eight weeks. The files are readily accessible on our office network. We can e-mail or print them out if necessary. They are in Acrobat PDF format so we can move them into an EMR program with minimal effort.    As for additional scanning tricks, Ambir ( has small business card scanners for approximately $160 each. We use these scanners when the patient initially checks in at the office. The patients provide a copy of their insurance cards and driver’s licenses. We scan these documents into our practice management program.    We have eliminated paper copies in the charts and there are no more questions as to the co-pay or dates of coverage. Without having to pull the chart and search through it, the card image is available to our billing and checkout departments. These scanners have the capability of optical character recognition (OCR) so one can directly import demographic data into the practice management system. This part still has some bugs that slow the process but it certainly has potential for the future.    We now scan all of our EOBs as they come in with the checks so we can discard the paper version after posting and cashing the checks. Our office has also scanned old payroll and tax records, invoices, bank statements and checks.

In Conclusion

   As a result of these changes, we have regained space in several storage closets and have greatly improved office efficiency. Now we can easily find documents at minimal expense and within a minimal amount of time. We are gradually eliminating all of the paper that typically accumulates in a medical office. Dr. Werber is a Fellow and Past President of the American College of Foot and Ankle Surgeons. Editor’s Note: For related articles, check out the archives at

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