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Saving on costs and cutting expenses are a goal of every medical practice, especially in these challenging times for health practitioners. But sometimes the daily tasks of running a practice can be so encompassing that time to sit down and make an honest assessment of budgets is a luxury. In the previous two articles in our “Practice Cost Savings” series, we have emphasized the importance of taking the time to evaluate the various moving parts of a medical practice. Being fiscally conscious is not separate from the daily operations of a practice, but should instead be integral to its functioning. We have explored this in various contexts, such as utilities, contracts, staff, supplies, waste, and oversight.

Now we will wade into a potentially trickier area of a practice’s financial platform: Technology. From Information Technology (IT) to Electronic Health Records (EHR), managing technology expenses in a medical practice can be confusing at best. Ahead, we will explore strategies to better manage these costs and hopefully save along the way.


When considering an EHR system, there are numerous savings and expenses that must be considered, ranging from obvious expenditures for the purchase of the EHR itself to the installation. One of the major decision points in the process is whether to select a cloud-based system or a centrally located server-based system. Cloud-based systems tend to be much less expensive initially, however, the eventual outlay can be significantly more expensive due to recurring charges.

One potential drawback of a cloud-based system is the lack of connectivity if Internet is down to the practice; this can result in the loss of system functionality for hours at a time, with concerning implications for productivity and patient satisfaction during those moments. Additionally, the solution to an outage problem may not be easily deduced, leading to hours of frustration on the part of the practice and the individuals that the EHR serve. It can theoretically grind a practice to a standstill.

The benefit of a centrally based server system is that data is onsite and easily obtainable in most situations. This, however, can’t be done by most practices without assistance of an IT specialist either onsite or within close proximity. Many practices may even consider hiring an expert or person with background in IT-based discipline in order to have an onsite technician. The other concern with having the system in your practice is security, as well as the incredible importance of maintaining and safeguarding patient records. Backup is also of paramount concern and must be handled daily in order to make sure that records are available within a short period of time when faced with a “worse case scenario.”

Cloud systems generally have backups integrated within their environment, and security is usually something that is included with that sort of program. That doesn’t mean that cloud-based servers don’t have security issues or losses of data, but the tradeoff for a cloud-based program is the measure of competence that they’re assumed to have. In all cases, however, buyers should beware due to the risks inherent in any new technological corporation or venture.

In our practice, we decided to go with a centrally based server platform because it was more reliable for us should our Internet be down for any reason. Additionally, we personally felt more comfortable with the safety of the information and backup processes. That doesn’t mean a centrally based server is the best answer for every practice. Rather, it is a decision that has to be considered over time in most practices, especially in light of the growing realities of EHRs.

One additional note for practices considering this transition is that there may be extra need for staff to act as scribes for inputting data to the EHR. We have adopted a method of data entry both via the physician and nurse, which allows us to be more efficient once trained. The end goal is to have a nearly synchronous process of note-taking during the visit, and to leave little or no transcription or written work for the dermatologist. While it would seem that this method can save significant transcription costs, the likelihood is that this is simply going to be a wash. This is because of the extra expenses needed for nursing personnel to input medical records and lab work, particularly while balancing other daily functions of patient registration and data input during the visit. Additionally, lab work entry has been a challenge with our new system, as not all labs offer the system we chose and this has resulted in more work for our staff to input this information.


While EHRs may help to reduce costs in some areas of your practice, they may also cause a spike in costs elsewhere. As the broader implementation of EHRs on a national scale moves forward, each and every office is going to incur greater software and hardware costs over time. Thus, your staff should have some familiarity and comfort with technology. Our practice has worked with an outside IT firm nearly since the inception of our practice-billing module in 1993. Over the years, our IT needs have become more complex, and the level of expertise needed has increased dramatically. Thus, we have taken our IT in-house at this point and have established an IT “help desk” individual to attend to things such as damaged computers, setting up computers, fixing printers, and safeguarding e-data, in addition to performing routine computer-based reviews. We searched for quite some time to find the proper individual for this task, but the reward has been that our staff is much happier, since the everyday goings-on related to technology are now handled efficiently with a better outcome than previously. This is something that every practice may confront in the future as they grow larger and encumber more IT-based issues in the everyday events of a practice. The benefit of an in-house IT staff member will vary significantly from practice to practice, but it is a huge asset on an everyday basis for our practice and likely to be a positive in many other practices.

Future Savings

Changing technology offers advantages and disadvantages to every practice. The examples quoted here are only the start for a 21st century dermatology practice. Over time, these examples may be antiquated and other more effective resources will be more obvious. Whether your practice is a small solo practice or large multispecialty practice, you will have to make important decisions as to what level of technology to incorporate and adopt over time. We hope this discussion has proven useful to you.

Our next and final entry in this series on cost savings will bring the discussion of savings and expenses full-circle, as we examine the ins and outs of how to create savings in banking relationships.

Joel Schlessinger, MD is Founder and Course Director of Cosmetic Surgery Forum. He practices in Omaha, NE. The 2013 Cosmetic Surgery Forum will be held from December 5-7 at the ARIA Resort & Casino in Las Vegas, NV. For more information and to register, visit www.CosmeticSurgeryForum. com. Feel free to address questions to him at JS@

Nancy Schlessinger, MS is Vice President of

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