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Dr. Jeremy Sharp Transcripts Leave a Comment

[00:00:00] Dr. Sharp: Hello, and welcome to another episode of The Testing Psychologist podcast where we talk all about the business and practice of psychological and neuropsychological assessment.

Hey, glad to have you here. My guest today, Rob Reinhardt does a lot of things, like many of my guests, but Rob does an extra number of things.

Rob is a licensed professional counselor. He’s been in private practice for over 10 years. He is active in plenty of state and national organizations. Rob is a column editor for  Counseling Today magazine. He’s also the creator of a card deck called the Describe Cards, which are activities and games for improving communication and understanding among individuals.

The reason that Rob is on my podcast today is because he is also the CEO of Tame Your Practice. Tame Your Practice is a business that Rob started that is aimed at helping therapists navigate [00:01:00] all things in technology, business, marketing, finances, really across the board. Rob has made a bit of a niche out of doing EHR reviews or electronic health record reviews. And that’s what he’s here to talk with us all about today.

We cover a number of things about EHRs: what they are, which ones are catered to assessment practices, which ones are best for multidisciplinary practices, solo practices, group practices, and how to determine your needs within EHR. We cover a lot. Rob is very knowledgeable about all of these things. I think there is a lot to take away from this episode, and I hope that you enjoy my conversation with Rob.

Before we get to the conversation, I will let you know that I am looking like I will have two consulting spots opening up in the next month. If you’re interested in individual consulting or coaching to help [00:02:00] grow testing services in your practice, I would love to jump on the phone with you and figure out if it would be helpful to work together. I love consulting with other practitioners and that is a big part of my consulting business. So let me know if that would be helpful. You can book a call at thetestingpsychologist.com/consulting and check it out to see if it’d be a good fit.

And now, without further ado, my conversation with Rob Reinhardt.

Hello, and welcome back to another episode of The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. Like you heard in the introduction, I’m here with my guest, Rob Reinhardt.

Rob, I’m really glad to have you here. [00:03:00] Welcome. 

Rob: Hey Jeremy, it’s great to be here. 

Dr. Sharp: Thanks for coming on. I met, well met, I got introduced to you virtually by our mutual friend.

Rob: I think we can just say met these days. People are used to virtual relationships happening, so you can just say met. 

Dr. Sharp: Okay. Thank you. I’m tired of working around that, to be honest. Okay. So we met via our mutual friend, Roy Huggins who’s been on the podcast. I got to meet in person a few months ago in Chicago. He is a pretty amazing person. So y’all have worked together and he said you need to talk to Rob and get Rob on your podcast. So here we are.

Rob: Here we are. Thank you, Roy. 

Dr. Sharp: Right. I want to dive right into it. You have a really unique niche in the private practice world. We’re going to be talking a lot about EHR systems and your thoughts about EHRs. Before we totally dive into it, I’m curious [00:04:00] why this for you? Why is this important or interesting? 

Rob: I just naturally fell into it. I’ve always been in the technology world. We had one of the first home computers at home. My mom worked for Honeywell. The Space Shuttle program is huge. So it’s not like she was an astronaut, but she was part of the Space Shuttle program. And so she had access to technology. We had one of the first home computers in our house that you didn’t even have a hard drive in. It ran off of floppy discs.

So I’ve been around technology my whole life. And so when I came out of graduate school and was diving into the counseling world, I saw that many counselors don’t have that technology background. And so as I started to look for an EHR and software to make my practice more efficient, I realized I had a lot of knowledge as well as this research that would be really valuable to people in private practice. And so I put it out there. And that’s how Tame Your Practice came into be.

[00:05:00] Dr. Sharp: Can you describe Tame Your Practice in your own words?

Rob: Tame Your Practice helps counselors, mental health clinicians, and private practices identify software and solutions that will help them reach their practice goals, whether it’s going electronic, making things more efficient, all of the above. 

Dr. Sharp: I love it. I’m personally super interested in this. That’s one of the reasons I wanted to chat with you because I could have seen myself going down that path in a different universe. I love technology. I love efficiency. When all these kinds of programs started coming out, it was hard not to dive into that world and actually stick with my practice. So I’m glad you did it, and now you can talk with us about it. It’s really cool.

About what time was that [00:06:00] happening or what year, I suppose, were you getting private practice and looking at this?

Rob: 2006 was when I was finishing up my practicum/internship. By 2007, I was fully licensed. I did all that in a private practice. I was fortunate enough to be able to do that in a private practice setting. So I got a lot of private practice knowledge right out of the gate and early on recognized how technology could help because this was, 2006-2007.

That seems very modern, but there still wasn’t a lot of technology being incorporated into private practices at that time. And the ones that were a lot of installable software. You’d get the CD and install it on your computer where Software as a service, cloud programs, things on the web were really just starting to come into being at that time.

I saw that that’s where things were going to [00:07:00] go. I saw that so many people in our field didn’t realize how technology could help their practices. And so, that’s how it all started. I was researching for that original practice that I was working for what’s out there. What can we use? And then in 2008, that practice closed down. I got thrown into starting my own practice and it all blossomed from there. 

Dr. Sharp: I hear you. It sounds like you were maybe a year or two ahead of me with private practice, but thinking back to that time, it was hard to find an EHR. I forget which one. I looked at an installable one as well, and I was like, this doesn’t make any sense because I’m going to be working on different computers and that would be hard and cumbersome.

And then right around that time, I don’t know, six months or maybe a year after that, I think [00:08:00] TherapyNotes came around. Can you remember what the other early ones were? I can only really remember TherapyNotes and maybe Simple Practice.

Rob: Yeah. TherapyAppointment was one of the earliest. It was around […] was around in that time, but they no longer exist. They actually merged with TherapyNotes about 2,3, maybe even 4 years ago. It all flies by so quickly.

Dr. Sharp: Yes.

Rob: There may have been others in their infancy at that time. There was a number that started as an installable software and then realized, Hey, we’ve got to come up with a cloud solution and developed one and had both, or had a hybrid type model. QUICKDOCS may have been already doing that at that time. The timeline is a little fuzzy. 

Dr. Sharp: I know. Well, it’s amazing to think about where we are now. In the span of 10 years, [00:09:00] I feel like the space is totally blown up and there are a ton of choices for people when they’re looking at EHR. I would love to talk with you about that.

Rob: And there’s a lot of benefits to that move. People are concerned about the, oh, I got to pay this fee every month and it adds up, and yeah, but when you were doing the installable software, you were often getting charged large amounts of money each year at subscription time. And so, you were still, even though you thought, oh, well, I’ll buy this software one time and I’m good, well then there’s updates and changes to CMS forms and insurance filing, and you’ve got to pay for the update if you want to stay functional.

On the whole, there’s actually a cost saving to the cloud services. There’s also an expediency in that when things are updated, you’ve got the updates. It’s not like, oh, wait, I’ve got to plan out this purchase of this [00:10:00] updated software. Well, now, when they add the updates to the cloud software, you’ve already got it.

And then with the advent of the HIPAA Omnibus Rule and all the security rule and then the need to be diligent about digital security and protected health information, you also have the benefit of now you’re offloading a good bit of that to the cloud service. If you’ve got that software installed on your computer, now you’re 100% responsible for securing that computer and that data and so forth. Whereas with a cloud service, you still have a number of responsibilities, but you can offload a good bit of it to that cloud service.

Dr. Sharp: Yeah, I think that’s an important piece to highlight just the fact that I don’t know that we think about that as explicitly and how much of a relief that might be or how much work we’re being saved when we sign up for an EHR.

Rob: Right. So I encourage people to think about, okay, let’s say you had a computer with protected health information on it and you were charged with making [00:11:00] sure it was secure. First of all, would you know how to do that? And if not, how much would it cost you to get somebody to do it for you? And so, you factor that into the cost savings and the return on getting a cloud-based service and it starts to become a no-brainer. 

Dr. Sharp: Absolutely. Well, before we really sink deep into this stuff, I’m really curious about your business, the Tame Your Practice, and your website, you have a lot of EHR reviews. I’m curious just about your process for:

1) How you go about reviewing an EHR and

2) Why build out that part of Tame Your Practice? How’d you really zero in on EHR reviews as an important service? 

Rob: I zeroed in on it because like I said, I did that research. I was looking for that unicorn way back then, the thing that had all the features I [00:12:00] wanted and it didn’t exist. So I ended up looking at it over a dozen of them and I’m like, wow, now I’ve got all this knowledge, let’s post it online and see what comes of it. And then people started coming to say, oh, well, which one is best for me kind of thing.

So it just organically happened at first. I’m going to put this up and I’m going to keep up with the EHRs and their updates and new features. Since then, I’ve had more of a systemic process in place where I revisit them every so often somewhat based on how often they’re integrating new features and so forth.

And the actual evaluation when I say, okay, here’s this new system that I’m going to look at, I do like most of us do. I do a free trial, create an account, use it like I’m a user, and look at it from a user standpoint. Is this easy to use? Is this user-friendly? I’ve got a database where I check off the features that exist.

So, I’ve [00:13:00] got those basic reviews up there, but behind the scenes, I’ve got those databases where I know if this system has that feature or that feature. So when somebody comes to me and says, Hey, here’s my prioritized list of things that I need. These are must-haves. These are things I’d really like to have. And then these are pie in the sky. I would love to have them, but if I don’t, it’s not going to break anything. I can immediately look at, okay, which system is going to most or best fit your situation.

So the process for me is going through, getting a feel for it as a user, learning curve, those sorts of things, but also checking off what features are available. And then once I’ve done that initial evaluation, the check-in is a little bit easier when I go back and make sure what features have been added and those sorts of things.

And some behind the scenes paying attention to the hubbub online in different groups about what people are [00:14:00] saying about customer service and other experiences that they have with the various vendors, as well as, what I hear from my newsletter subscribers and clients, and so forth.

Dr. Sharp: I like that. And that might be a nice segue, honestly. I feel like a lot of the EHRs are comparable, but customer service is one of those places where one starts to stand out or sink. Just off the top of your head, do you have thoughts on ones that have “better customer service” or ones that are easier to get ahold of than others if we do have problems? 

Rob: Well, keep in mind that anything I have would be anecdotal. So one of the reasons I put a lot of stock in what am I hearing from other people is that, sure, I test customer service when I’m [00:15:00] evaluating things. I’ll send them questions, and see what kind of response I get, but they know me. So, there’s probably some bias there. I’m guessing they’re more likely to jump on anything I send to make sure I think that customer service is great.

What’s interesting is a lot of times, the ones that float to the top tend to all have good customer service. A lot of times it’s about format. For example, there are ones that bank on phone support and there are ones that bank on email support. And you’ll hear different responses from people based on what their personal preferences are.

So the people who are like, I want to pick up the phone and get ahold of somebody are going to complain about the company that only offers initial email support, whereas people that are like, hey, I’m always busy. I’d like being able to fire off an email and get a response in between sessions or when it’s convenient for me, I don’t want have to get on the phone and maybe get put on hold or whatever. [00:16:00] They’re going to say, oh, I love email support.

So, in my experience, the ones that tend to float to the top tend to have generally positive customer service reports depending on those kinds of factors. Does that make sense? 

Dr. Sharp: Yeah, it does. Maybe just one step of this process for a clinician trying to figure out what EHR is best is really thinking about your style; do you want to pick up the phone or do you want to send an email? I am an email person 100%. 

Rob: So you’d be like, why do I care if it’s email support? That’s great. It works for me. Whereas somebody who wants to be able to talk to somebody on the phone feels differently. And that’s part of the process I go through with people in evaluating what’s going to be a best fit for them.

And the other step I always encourage people to do is the same thing I was talking about when you’re at that point where you’re evaluating one to see if it’s going to be a good fit for you, ask them questions. Even if it looks like [00:17:00] it’s easy to use and everything is covered, make something up. Ask them some questions. Gauge what kind of support you get. Do you feel like they respond in a timely and professional manner and all those things?

Dr. Sharp: That’s a good thing to touch on as well. I know we keep pushing back the questions about specific EHRs, but these are good topics coming up. Do you have a process that you recommend folks go through when they are trying to decide on an EHR?

Rob: I do. There’s three versions of this. I’ve got a five-step process that I encourage people to go through that you can find on the tenure practice website.

I actually have an ebook. If you want to get into the nitty-gritty details and have me completely walk you through the process, there’s an ebook up on Amazon that you can purchase. But there’s also a free version. When people subscribe to [00:18:00] Tame Your Practice, they have access to the free version, which gives you the basic, Hey, here are the five steps. Here’s what each of them means, here’s what you should do, and the basics of what you should do in each step. And the ebook adds things like a lot more questions to ask and checklists to go through and those sorts of things. 

Dr. Sharp: I see. Wow. That’s great. I will link to that in the show notes so that people can check out both of those options if they want to.

Rob: We can talk about some of the steps. The first step is to actually assess or think about what is it you want in a system. Why are you thinking about going to a system?

A lot of people will dive right into asking other people, Hey, which one are you using? And I really caution people against that. Not against ever doing that. I think that’s an important part of the process. Hey, what’s the feedback you hear from other people?

But more important than that [00:19:00] is knowing why you’re using the system. Because if your main goal is I want this client portal to be fully featured, I want to go paperless and have people fill out their intake paperwork online and pay their bills online and submit secure messages online, whereas this other person you’ve asked, Hey, which one are you using? They don’t care about the client portal. They’re focused on insurance filing and features like that, well, they might send you in the wrong direction. They might be really happy with a system that is excellent at insurance filing, but doesn’t have much of a client portal. So now you’re spinning your wheels.

So it’s really important to have an idea right up front, why you are wanting to use an EHR and starting to develop your needs list of hey, these are the things we need this system to accomplish. 

Dr. Sharp: Yeah, that totally makes sense. We get a lot of questions, and I love our Facebook group, but there’s a lot of that like, [00:20:00] which one do you use and what should I go with? There are a ton of choices and it plays out a lot like you say. People are like, I like TherapyNotes or Simple Practice is great, but I don’t see a ton of that sort of deliberate planning of what features do you actually need?

Rob: Yeah. And so I think those questions are, and I melded the first two steps in there. When you get into the third step of evaluation, that’s when you ask the questions in the groups. The first step is to conceive. Hey, I want to do this. Why am I doing this? The assess step is okay, let’s put it down on paper or in a spreadsheet. What are the features we want? What priority does each feature have?

And then now that you’ve got it narrowed down, and now you can ask better questions to those groups. Hey, I’m looking for a system that does X, Y, and Z. These are my top priorities. Who’s using one that does these really well?

Now you’re getting more specific. You can get more quality feedback [00:21:00] from people than if you just say, Hey, what’s everybody using? Because you’re going to get 12 different answers to that question. And now you’re still at square one. When do I have time to invest in researching 12 different systems?

Dr. Sharp: Absolutely. So thinking about these steps, I would love to go full circle with these. What are the other steps in your process? 

Rob: Once you’ve assessed, you’ve got your needs list, then you evaluate which system is out there, check the boxes. Which systems have most of the features I want, especially the must-have features? And then you can actually go into narrowing it down. Hopefully, that whole process will narrow it down to two, maybe three, then you do some trials and demos.

I absolutely encourage people to do trials. Demos are great, but anytime you do a demo, you’re working with somebody who knows the system in and out. They’re probably on an optimized server, probably a [00:22:00] local server where their connection is really fast and everything looks slick and clean because they’re just flying where they know what they’re doing, right?

Dr. Sharp: Yes.

Rob: So you don’t get a good feel for what’s it going to be like for me to learn this system? Does this match my workflow and my natural way of going through the process? So it’s really important to that trial because that trial will also generate those questions that you can ask to help assess their customer service.

Dr. Sharp: Sure. So maybe it goes without saying that during those trials, it’s important to keep track of the things that are going well, things that are not going well, questions that are popping up, things you like, things you don’t like. 

Rob: Absolutely. And this is where the book that I wrote helps you a little bit more. The process can be more detailed depending on whether you’re a solo practitioner or a group. You might have different stakeholders involved in that decision.

If you’re in a large group and the biller is like, Hey, well, I’ve got these things that are really important to me and the [00:23:00] scheduling staff has these things that are really important to them and so forth, and the clinicians are like, yeah, but we need to make sure the note-taking is really easy. So you have a lot more people to please and needs to cover there. 

Dr. Sharp: True. Cool. Well, that’s great. That sounds like a fantastic resource.

I wonder if we could maybe talk more specifically about EHRs and the different needs. I’m trying to think of the best way to tackle this, but maybe I’ll just go with our audience and start there. So, from what you can tell, have there been any EHRs that seem to really span the services and account for testing as a service and a practice better than others? 

Rob: Yeah. That’s really a gap. There’s a real [00:24:00] opportunity here for some EHR to step forth. I’ve talked to testing psychologists all the time. One of the questions I always make sure I ask when I run into a testing psychologist is, how are you documenting your test results, your reports that you send out? And invariably they say, oh, I’m having to use Microsoft word templates or some third-party software. So there’s real opportunity here.

There are EHRs that will let you create templates and structured notes where you can actually say, okay, I’m going to create this template for a note that has check boxes and pull-downs and so forth. So there’s tools there to potentially create something that works for you, but there’s no EHR that I’m aware of that just straight up has some tools that mimic what psychological testing reports typically look like. And that’s the thing. When I see those reports, a lot of them look the same. I don’t know if you guys are sharing templates.

[00:25:00] Dr. Sharp: Of course, we are. 

Rob: That’s what people in our field do and that’s a good thing, but I’m not aware of any EHR that comes close to mimicking that. Somebody would have to rebuild that in the EHR using some customization tools 

Dr. Sharp: That’s even a separate problem that I wasn’t even thinking about. That would be incredible if there’s somehow an EHR that would build in a report writing template or software or something. That would be maybe a huge time saver.

Rob: Again, there are some systems that can mimic it and you might be able to even manipulate it to do what you wanted it to do.

The other thing is I always caution people, whatever you do, do not go into an EHR based on one feature that has sold you. Because invariably, when I’ve seen people do that, they come back later and say, oh, but I didn’t realize it was missing [00:26:00] A, B, and C. This one feature was awesome. It was everything I was looking for. I finally found it, but then I later found it doesn’t have this other thing I need or doesn’t do it well or what have you.

So what were you thinking about? Because there’s a huge opportunity there for one of these EHRs to support documentation of testing. What was it that you were looking for? 

Dr. Sharp: I was thinking more about the note template for testing appointments. So something that can easily document the different amounts of time that we spend on different tests. Well, that’s really the big one, because we’re required to document how much time we spend on each test. And that bills for multiple units. That’s another thing about testing that’s different than therapy. We bill multiple units on the same day. Does it do that well?

Rob: Most of the systems that can file insurance claims will have [00:27:00] some way to address that. Whether it will meet all your needs, whether it connects the time to the note the way you want it, then you start to get into subjective measures.

So in other words, I can say, oh, this system can create a note and have a time and a length of session in it. But if you’re then like, okay, but can it let me do these other three things associated with that note, then we start getting to subjective details.

So most of the systems are going to let you create variable appointments, especially attached to CPT codes. Okay. Well, I think I’m going to have these four different CPT codes attached to the same session and note the times involved with them, or at least create separate sessions. If you’re using ad-on code, you’ll be able to do that. So you start to get into okay, but does it do it in the format you want it in? Does it match your workflow? That sort of thing. 

Dr. Sharp: Right. Okay. Well, that’s good to hear. So those are [00:28:00] pretty common features that most EHRs are going to have then. 

Rob: Right.

Dr. Sharp: Cool.

Rob: You got to keep in mind, I don’t know how much variance there is in the psychological testing world. You always have to check into, if you’re filing for insurance and I know it’s very regional as far as whether insurance covers psychological testing and so forth, but you have to look into, how does that work in my state and how does insurance require coding in my state and make sure that EHR can address that. 

Dr. Sharp: Sure. So let’s zoom back out then and think about broad strokes with EHRs. Have you noticed any at this point that are rising to the top, if we had to name big 5 or a big 3 or something like that seemed to be the most popular.

Rob: So keep in mind, I don’t have actual market research data. So this is anecdotal as wel. The [00:29:00] ones that are pricing the most traction these days would include TherapyNotes, Simple Practice, Therapy Appointment, Theranest, and Psybooks. I’m probably missing some. I’d have to pull up my review page. So those are some of the ones that are forward moving, getting the most traction, but there’s a number of other ones. There’s some new ones that are on my queue to do a first review of. 

Dr. Sharp: oh, what are some of the new ones that you’ve seen?

Rob: Some new ones that have only recently either come into being or branched into serving the mental health community are Jane and Theraplatform.

Theraplatform has actually been around for a bit. It originally was focused on telehealth secure video. So there’s a lot of hybrids and crossovers where a system will start doing this one thing and then decide, Hey, our customers are asking for [00:30:00] these other features, let’s branch out and add some new stuff and become more of a full-fledged practice management system.

I was just speaking with the CEO of YellowSchedule yesterday. There’re only 2 or 3 online scheduling systems that comply with HIPAA. YellowSchedule is one, Acuity is another, Full Slate. I was talking with Martina Skelly, the CEO of YellowSchedule, and they’ve been around for quite a while now, HIPAA-compliant focused on scheduling, but they’ve had so many people say, Hey, have you thought about incorporating notes and this and that and the other thing, and they’re finally starting to do that sort of thing.

So you’re seeing more and more of that. I’m very curious what’s going to happen with the market over the next five years. At what point is it oversaturated and companies start merging and they’re now consolidating and those sorts of things? Right now [00:31:00] there are a lot of companies being successful. There’s a need. 

Dr. Sharp: Yeah. So this is a totally random question. Maybe a question you cannot answer at all, which is fine, but the tech part of my mind, when you say that companies start in one direction and then build in these other features that we need. Do you have any idea of the suite of services that a lot of us want?

So let’s just say like online paperwork or client portal, scheduling, billing, notes, from a tech perspective, are any of those tougher to build than others? Do you see what I’m saying? Like, is it easier for a company to start as like a telehealth company and then just add in notes and billing or vice versa?

Rob: That’s a tough one to give a concrete answer for because there’s so many factors involved there like, what’s the software platform that they’re using to [00:32:00] develop, and are they using in-house people or contractors from out of country and a lot of different things. But the short of it is that the things that tend to be the most difficult would be the integration of insurance features. So filing and ERAS, electronic remittance advice. 

I want to say client portal, but it depends. The client portal tends to be broken down into pieces. And so it depends on which piece of the client portal you’re talking about, but getting to the point where you have a full-fledged client portal, where you’ve got scheduling and bill paying and secure messaging, all of the things that people might want, that’s a challenge to get that entire structure in place.

Dr. Sharp: That seems like  it.

Rob: Most of the big groups, I didn’t mention Counsol. Counsol [00:33:00] is another example of one that is fairly successful these days. They started out really focused on solo practitioners and were one of the very first to have secure video integrated. And for years like, hey, we’re probably not going to do insurance because we’ve got our niche here with solo practitioners who do telehealth and even they have integrated insurance features at this point.

So it seems like there’s enough practitioners out there that want it all or bigger chunks of features that a lot of companies eventually go that direction.

The insurance and client portal are probably the most difficult to implement. The telehealth, I’m sure there’s complications there, but most of the vendors are working with third-party services. So, the challenge there is just, okay, how do we integrate it? We’re not having to build this secure video platform. We’re working with this third-party vendor who already has [00:34:00] done that and they know that. We just have to figure out how do we integrate it without our platform so it looks seamless. 

Dr. Sharp: That’s a good point. Well, thanks for bearing with my curveball question there. That techy curiosity. 

Rob: Your questions are good. Keep me on my toes. 

Dr. Sharp: Nice. I’ll try to keep doing that.

Well, I would like to talk about specific features and maybe tackle it from a practice structure perspective. I know there are some that may be better for solo. Some that may be better for group. I would love to selfishly touch on multidisciplinary practices because that’s the very quandary that we find ourselves in right now having hired a prescriber. So maybe just starting with solo practitioners, like one person solo practice, are you noticing any rising to the top in terms of…?

Rob: Honestly, with solo practitioners, they’ve [00:35:00] got the pick of the litter, so to speak. It used to be that…

Simple Practice is another one that started out as, Hey, our niche is focusing on solo practitioners. We’re not going to support groups right now. We’re just going to focus on being the best for solo practitioners. They have added group functionality. So solo practitioners are in a good position in that pretty much all the systems they might evaluate are going to be within the pool of possibilities for them. It’s going to come down to what are the features that are most important to them.

If the client portal’s the most important, they’re going to go with one of the systems that’s got a fully featured client portal, for example. So there’s not really a system or systems that are like, Hey, so practitioners, we’re the ones for you. So practitioners can look and say, Hey, which one’s got the stuff I want?

[00:36:00] Dr. Sharp: That’s good to hear. Well, it’s a curse and a blessing I could think. You have all the choices in the world, but…

Rob: Yeah, that becomes problematic. But again, if you’ve done that needs assessment, you can quickly narrow it down.

Dr. Sharp: Right. That’s what I was thinking. It just seems to come back to knowing what you need and what’s most important. 

Rob: Right. I’m bringing this up again, not as like, oh, this is the one that always people make their decision based on, but it’s a good example, the email versus phone support. If on your needs assessment, you’ve got a high priority for phone support, well, you’re going to be able to check certain systems off because they’re not going to meet that need. The same thing with, oh, I absolutely have to have integrated ERAs. That’s going to check a couple off. You keep going down that list and it narrows it down for you.

Dr. Sharp: That’s such a good point. Okay. Solo practitioners, that’s easy. You can pick anything. Do your needs assessment. 

Rob: Yeah, you do your needs assessment and that’s going to help you [00:37:00] narrow it down. And then it can be a subjective choice if there’s two that are both meeting your needs.

Dr. Sharp: Nice. So what about folks then who moved into a group practice? We have multiple clinicians. Are there any right off the bat that you know of that don’t really cater to that population? 

Rob: It will come to your needs. So for example, if you don’t file insurance, you may again, still have a pick of the litter as a group practice, because most of the systems now do work with groups. So it also may depend on how large your group is. If you are getting into 20+ clinicians with a lot of different offerings for services, you may be stepping into a larger, slightly more expensive system especially if you need a lot of customization, because a lot of the less expensive, easy-to-use systems, don’t offer a ton of customization of features and so forth.

Dr. Sharp: What do you mean [00:38:00] when you say customization of features? 

Rob: For example, here I am, I’m having Monday brain on a Thursday. I’m blanking on the name. Let me pull up my ClinicTracker. ClinicTracker is a system that has a customizable dashboard. So you can see a different dashboard when you login; whether you are a biller, a clinician, or an administrator, you can customize what you see when you log in.

A clinician might want to say, I want to see my appointments for the day and tomorrow and any notes that I haven’t completed, whereas a biller might want to see, well, what insurance claims need to be filed, which ones are past that 30-day point, those sorts of things. You can do that kind of customization in that system.

Dr. Sharp: That’s cool.

Rob: So again, I know I’m being redundant. A lot of it comes down to [00:39:00] that needs assessment. What is it that you need? Are you looking for simple or are you looking for customization? Those sorts of things.

Dr. Sharp: Yeah. I should have asked this back when you were talking about your ebook, but is there a chart somewhere or a list of needs that folks can run through to help them figure that out?

Rob: Yeah. In the ebook, there’s a checklist. It covers as many of the needs as I can. I’m always running into people who do my consultation services that have some need I hadn’t thought of or hadn’t run into before. The ebook has a pretty extensive list of things to look at and cover. Where it doesn’t get into super specific details, it offers the leading questions that help you get there to say, Hey, you need to explore this area and make sure you document what your needs are in this area.

Again, this is just one specific detail. Another thing I run into with groups is in [00:40:00] evaluating systems is whether you’re doing air billing internally or not. Some groups will have their own internal billing staff. Others say, even as a group, we don’t want to hire staff to do that. We want to farm that out to a third party.

So one of your decision points there is, are we doing it old school style where we have some export, whether it’s a secure email or fax or whatever, where we send the bill or all the stuff we need to have them billed, or do we integrate with somebody who uses one of these EHRs?

So there are billers who will work with some of these EHRs. And so now you’ve got this extra decision point in there. Okay, we’re really leaning toward EHR B, but we can’t find a biller who works with it. This other EHR, the second choice, we know this really good biller who will use that system. So is that a big enough tipping point for us to choose that other system? 

Dr. Sharp: That’s a great point. [00:41:00] As far as I know, there are folks that work with TherapyNotes specifically billers, and I’m not sure about other EHRs. Have you found that billers are starting to specialize in and work in the other EHRs as well?

Rob: I don’t know how much. If any of them are specializing, I don’t know when they would, but I know there are a number of them that do work with one or more of the EHRs. And I know that many of the ones that we’ve mentioned are in that pool. I know there are billers who you can connect with who will work with Therapy Appointment, Theranest, and Simple Practice.

I’m seeing more and more EHRs advertise that as a plus. “Hey, by the way, here’s our list of billers who work with our system if you’re looking for somebody to handle your billing for you.” Our system will make your billing [00:42:00] super easy, but if you want help, here are some people that will help you and know our system in and out. So that’s becoming a selling point for them.

Dr. Sharp: Certainly. It sounds like for groups, the needs assessment gets a little more complex. There are a few more layers perhaps, but it still comes back.

Rob: You mentioned multidisciplinary practices and you start getting into, okay, do we need e-prescribing? It’s in the same vein of psychological testing that we talked about before. There are at least some systems out there that do e-prescribing. 

Dr. Sharp: Can we talk about those? That’s on my to-do list when I get off this podcast interview. 

Rob: Yeah. It’s interesting because I think that will be one of the things we see incorporated into the more popular systems that we’ve talked about so far. Or I shouldn’t say popular, but the [00:43:00] sleeker user-friendly systems that we’ve been talking about so far.

I think within the next two years, at least two of them are going to have e-prescribing because there’s been such a call for that. But there are systems out there. ICANotes is one that has had e-prescribing. I mentioned ClinicTracker earlier. That’s one.

The ones that have e-prescribing tend to be a little more complex, have a little bit more of a learning curve. And so, a lot of times people come to a point where like, okay, there’s these systems that have e-prescribing, but these other systems are more user-friendly. How badly do we want e-prescribing integrated or do we need to get an external third-party system to do the e-prescribing and use the user-friendly system?

So again, it comes back to that needs assessment. What are your priorities? What’s more important? Having all the features or having it be more user-friendly?

[00:44:00] Dr. Sharp: Yeah. It seems like in the search that I’ve done, because we hired a nurse practitioner a year ago and in our state, they are required to move to e-prescribing by 2020. So this is pretty important to try and figure out. It seems like there are a lot of medical EHR systems that were written for physicians and they build in therapy and psychological testing but it’s clunky. I haven’t found many that go the other direction that were built for us.

Rob: And they tend to be more expensive- those medical-centric ones.

Dr. Sharp: Oh my gosh. Yes.

Rob: In a lot of cases, they’re ONC certified, which means they’re meaningful use certified. So we go back to the affordable care act and their drive to integrate EHRs and get them to talk to each other. There was a program physicians to get money to help pay for EHRs that did this and so [00:45:00] forth that the mental health community was mostly left out of.

And so the medical-centric systems had to have more features and spend more money on development and also serve a market that tends to have more money to spend on such things. And so, yes, you’ll see very medical-centric systems that have e-prescribing and pay a little bit of attention to behavioral health in there just because they see the market.

Those tend not to be a good fit. Again, it depends on the practice makeup. If you get a team of psychiatrists with two counselors, you might end up using a system like that.

Dr. Sharp: That makes sense.

Rob: The counselors that has one psychiatrist on staff, you might not find your needs getting met with those.

Dr. Sharp: Sure.

Rob: Valant is one that is in between there. It’s a more robust complex system and includes [00:46:00] e-prescribing so forth, but is also behavioral health centric. So there are two choices out there if you want e-prescribing, but none in the simpler, easier to use, user friendly market that I’m aware of yet.

Dr. Sharp: I got you. You mentioned third party options for tacking on e-prescribing. I’m not sure if you call it standalone eprescribing or something like that. Have you run into any systems like that that are quality?

Rob: I’ve never evaluated them. So I’m hesitant to say, oh, this is the one you want to use.

Dr. Sharp: That’s fair.

Rob: I know just anecdotally from hearing. Surescripts, I know is a hugely popular one that a lot of people use. I couldn’t tell you whether it’s a great system or bad system. Only that a lot of people use it.

Dr. Sharp: Yeah, that could go either way.

Rob: Other people are using one of the med-centric EHRs just as [00:47:00] an adjunct, just to have that e-prescribing feature.

Dr. Sharp: Right. Now I know that something that comes up for a lot of group practices is a check in feature. Do you know any EHRs that have a check in feature at this point?

Rob: Really, unless somebody has added something recently, mostly the larger, more customizable ones would have that. The simpler ones haven’t integrated that.

There are two things like that, that I’m like, how has this not happened yet? Like tracking referrals. A lot of these simpler user friendly ones don’t have the ability to track referrals very well. And even some of the ones that do don’t have an easy way for you to run a quick report to say, hey, how many referrals have we been getting from this person or that place or what have you, which is significantly important for a practice to know where your referrals are coming from. 

Dr. Sharp: Yeah, it sure is. I might be jumping the gun a [00:48:00] little bit, but since it’s coming up, I want to ask, are there other big features that you’re seeing that are missing from EHRs at this point that might be on the horizon or?

Rob: Yeah. The e-prescribing is a big one. I think the vast majority of mental health practices don’t have a psychiatrist integrated, but there’s enough of them that I hear about that a lot that, Hey, I’m looking for one that’s got e-prescribing. Does that exist? Telehealth- a lot of them have integrated that now. Having the full-featured client portal where you can be fully paperless doing everything through the portal.

There’s a number of things potentially slowing down development. Like you talked about, oh, everybody’s got to be able to e-prescribe by 2020 in our state. Well also in a lot of states, health information exchanges are happening. Are you familiar with that program?

[00:49:00] Dr. Sharp: Vaguely. 

Rob: The short version is, again, back to the Affordable Care Act. Our goal is to get all these EHRs talking to each other. And so every time you go into a new physician, you don’t have to start all over. They can look at your doctor’s records and recommendations and so forth. Well, that hasn’t been going that great.

Dr. Sharp: I imagine that.

Rob: Part of the problem is they threw money at physicians to say, here’s some funds to help you get EHRs implemented, but there wasn’t a real good program to get the EHRs to incentivize them to talk to each other. So here you have these privatized corporations building an EHR, and they have no incentive to make their EHR to talk to this other EHR. They had to build the ability in. That was part of getting certified for those. They had to make sure everybody was implementing it well, and so forth and so on.

There’s a lot of other factors involved, but what it came down to is the federal government finally said, okay, [00:50:00] this job is not getting done. Let’s throw money at the states and have them do it. And so money was made available to the states to create what are called Health Information Exchange.

Think of it as a central information point where all the EHRs can send that information and then talk back to it. It’s the middleman so that all the EHRs can talk to that system, trade information, and ease that burden of making the system all integrated and the EHR is talking to each other.

The challenge then, especially for behavioral health is that states like my state, North Carolina are requiring that in certain cases. So where mental health professionals have not been involved in meaningful use at all, now, suddenly we’re being told, well, for you to get state funds for providing services, you have to integrate with the HIE. And here we are using systems that have never had to deal with this before. 

Dr. Sharp: Sure. So what’s the outcome then? Do we have to switch to a [00:51:00] one of these medical systems that are more

Rob: Again, it depends on your state and what the timeline is. In North Carolina, there was such an hubbub, and it was finally recognized that this was putting a burden on behavioral health that it got delayed a year. So the outcome is we wait and hope that some of the systems we’re using develop a way to talk to the Health Information Exchange, because otherwise, it presents a financial burden for a lot of practices to move to a meaningful use certified.

Some are even thinking about, well maybe we’re just not going to accept state funds. We’re not going to participate in Medicaid or in the state employees’ health plan, which is 700,000 people in the state. So it’s a pretty big decision point.

All that to say, that’s something that a lot of these EHRs are having to deal with. And this is just North Carolina, there’s 50 states that are integrating HIE in some fashion. And a lot of the states, in North Carolina, the state is doing it [00:52:00] themselves, but in a lot of states, they’re contracting out to a third party. Hey, third-party, you build our HIE.

So now imagine you’re an EHR vendor and trying to track what each of the 50 states is doing with HIE and how you may or may not communicate with that. Now, they have a little bit of benefit in that it’s a standardized communication method, much like our insurance filing. There’s a standard format and language that’s used. So that expedites the process a little bit. Still, you got 50 different timelines and so forth. So that’s taking away some of their bandwidth to add some of these other features that we actually really want.

Dr. Sharp: What a nightmare.

Rob: Adding e-prescribing and fully fleshing out that client portal and so forth. 

Dr. Sharp: I got you. My gosh. Well, that seems like a wait-and-see kind of thing. We’ll see how that unfolds. 

Rob: Right. And I encourage everybody to take a look, Hey, what’s going on in my state with HIE? 

Dr. Sharp: Right. Geez. So [00:53:00] good to know about some of those behind-the-scenes issues that are holding things up. That sounds like a really tough job for everyone to build that system.

Let me see. We’ve covered quite a bit. I think I would be remiss, a lot of people have talked about IntakeQ. I’m sure you’ve heard of IntakeQ. They, I think, are one of those systems that started out as an online paperwork portal, and now they’re adding more and more features with scheduling and building out to be more of a full-featured EHR. Have you reviewed them yet or do you have any thoughts about them?

Rob: They’re on my radar. I’m very curious to see where they go with it. A number of people navigated to IntakeQ because they were using an EHR that didn’t have that full-fledged client [00:54:00] portal, where they could go paperless and have people fill in those intake forms online. And so, like you’re pointing out, IntakeQ realized, oh, well now these people are asking for more features. They want to be able to do the notes and they’re starting to add those things.

I haven’t looked at it closely and reviewed it yet because even on their website, they acknowledge, Hey, we’re not trying to be a fully integrated practice management system. That may change if they keep moving in the direction they’re moving.

And so, there’s not really a comparison between them and some of these other systems yet. Still, I’m aware of them. I keep them in mind. If somebody says, Hey, I’m a solo practitioner and all I want to do is do my intake paperwork online and some scheduling. I still am happy doing my notes in a word document and tracking my bills in an Excel spreadsheet or what have you, I might point out [00:55:00] IntakeQ to them.  Hey, this will let you do your paperwork online and some scheduling and you’ll be good to go.

Dr. Sharp: There you go.

Rob: So it’s good. And that there’s all these systems that play a different role and different ones might be a good fit for different people, but it’s also a challenge. It can be overwhelming when you’re looking for something and you are trying to figure that out.

Dr. Sharp: Sure. There’s so much to consider. My gosh.

Rob: Right.

Dr. Sharp: Let me see. I might ask you about one specific feature just to follow up on this theme we’ve been talking about- the online paperwork client portal. Are you seeing any EHRs that are rising to the top in terms of a really quality online portal, client paperwork situation? For me, this would mean fillable PDFs, and e-signature, where there is really no need for any paper forms for intakes.

Rob: Yeah. The three that have the most [00:56:00] features. Well, ICANotes would really be on the list too. Simple Practice, Therapy Appointment, Theranest, and ICANotes. Again, ClinicTracker would be in there too. It depends on what are my other feature needs. Am I looking at only the simple, easy-to-use ones or do I need a complex customizable one? But those five probably have the most full-featured client portals as far as checking off the boxes, having intake documentation. You say e-sig, in most cases in a client portal, the signature amounts to check in a box.

Dr. Sharp: That’s a good point.

Rob: Hey, I’m signing this. A caveat, I’m not an attorney. My understanding is that it passes muster for legality purposes, but certainly, I encourage people to check with their attorney to be sure. [00:57:00] But yeah, from filling out forms and scheduling and paying bills and secure messaging, those all have most of those features.

Dr. Sharp: Nice. You’ve mentioned, I don’t know the spelling on this, ICANotes? What is ICANotes notes? 

Rob: ICANotes is interesting. A lot of the ones we’ve been talking about are web browser based. In other words, you go to your web browser and you go to a web address, a URL, and you open up the system and you’re doing it all right there in your web browser.

ICANotes is still software as a service in that the application exists on a server out there somewhere, but you have an app that you have to install on your computer and open it. It’s separate from your web browser. You open that application and it accesses.

It adds a little bit to the learning curve. It makes it a little more challenging to use on mobile devices, especially phones. You might pull it off a little more readily on a tablet. Not quite [00:58:00] so user-friendly on a phone and so forth. 

Their biggest selling feature is their note builder. They have a lot of pull-downs where you can just go through and the pulldown menus have multiple options to help you build a really professional-looking note. That’s been one of their big selling features over the year. They have a lot of other features as well, but that’s their hallmark. 

Dr. Sharp: Got you. I’ll put those in the show notes as well just to try to expose folks to all the options out there. 

Rob: Mm-hmm. 

Dr. Sharp: Nice. Well, this is great. Our time has flown by. I feel like we’ve covered a lot, but very quickly. Before we totally wrap up, this is a big question, but are there other things for folks to consider as they are choosing an EHR; things that feel important to leave our listeners with?

Rob: Yeah. Take your time. It’s a big decision. It is a pain in the rear to [00:59:00] switch.

Dr. Sharp: I wanted to ask about that actually.

Rob: You want to do your best job making a choice at the beginning, and part of that is looking at not just where you’re at now, but where your practice is going to be in five years. So, really with any of your business decisions, I encourage you to sit down and take the time to develop that five-year plan.

Life changes. It can change, but you really need to have that vision of what I want this practice to look like in five years and put things into place now that will facilitate that. So even if you are a solo practice right now, and you’re like, I just want to pick something that’s going to be quick and easy, if you think you’re going to be a group practice in five years, I encourage you to look at, okay, I need to pick the system now that’s going to help me get there and still be usable in five years.

And that’s, again, some of the details I get into in the ebook, but that’s incredibly important because it is not easy to switch [01:00:00] systems. 

Dr. Sharp: Yeah. Can you speak to that just briefly? Maybe it’s just enough to say it’s not easy, but…

Rob: The biggest challenge is the information just isn’t portable. So you can probably port your client demographic data from system to system because that’s pretty standard. First name, last name, address one, address two, zip code, et cetera. But once you get beyond that, the systems are all using their own proprietary databases to set up how they do notes and billing and insurance filing. You’re probably not going to be able to export from one and import to the other.

So when you move, you might get your clients over, but then you’re looking at starting all over with scheduling and billing and so forth. It’s manageable, but it’s a hump to get over. So you really want to pick one that’s going to last you. 

Dr. Sharp: That makes sense. 

[01:01:00] Rob: The good news is if you end up in that situation, sometimes people end up in the situation that they’re leaving in EHR because they’re retiring or they’re moving on to another line of work or what have you, a lot of the systems will allow you to retain a free or reduced cost account as long as you’re not adding new information because they understand that we have an ethical and legal responsibility to keep our records for 7 to 10 years after the fact. And so, you need somewhere to store all that.

So one thing that can happen is when you transfer systems, you can always keep the old one as a legacy record. Hey, okay. All of our old clients are over here. We don’t have to try to port everything over. We can at least still access that information.

Dr. Sharp: Do you know of, are there any of the EHR systems that are more user-friendly to help port information from another system? Do they advertise that at all or help with that?

Rob: They will advertise that they’ll help, but they’re going to [01:02:00] still run into the limitations we just talked about.

Dr. Sharp: Okay.

Rob: There’s only so much they can do. Now, they might be able to massage some of that data in and at least get, okay, we can at least get your current outstanding balance in for each client, but will there be an extensive billing record of everything that’s happened in the past? I am doubtful they’re able to pull that off. It’s just too much manipulation and identification of the data that might be in a completely different format than what they store in their database.

I’m not saying it’s impossible. There may be cases out there where somebody’s able to do that, but I’m skeptical that that’s happening in any great amount.

Dr. Sharp: Sure. All right. This is good. I appreciate it, Rob. 

Rob: Thanks for having me. 

Dr. Sharp: I feel like there’s so much to talk about. I mean, we could dive into a ton of detail, but your website has a lot of information on it. This e-book sounds fantastic. I didn’t know about [01:03:00] that, but I’m glad that we touched on that too. But hopefully, folks are just walking away with, it seems like the theme is be deliberate, evaluate your needs and take your time in choosing an EHR, because there just more and more choices out there at the longer we go.

Rob: Yeah. And pick the one that’s going to last. The e-Book is there. The free version is available on the website. I’ve got my reviews that I keep updated on the website as well to help people choose. And if they feel stuck, I’m more than happy to help them figure it out.

Dr. Sharp: Awesome. Oh yeah. What’s the best way to get in touch with you if people want to reach out? 

Rob: tameyourpractice.com. The whole vision of that was, oh my gosh, I’m overwhelmed with paperwork and all this administrative stuff. I just want to help clients. Okay, well, let’s tame that part so you can focus on helping your clients.  

Dr. Sharp: I love that name. It makes sense. I get it.

Well, thanks again for the time. This was [01:04:00] fantastic. I really appreciate it.

Rob: I enjoyed it. 

Dr. Sharp: Hey, thanks y’all for listening to my interview with Rob Reinhard. Hope you took a lot away. I think the decision about an EHR is one of the most important decisions we can make. You spend a lot of time in your EHR and it pays to be really deliberate about that. So check out all the resources that I provided in the show notes, especially Rob’s decision-making tool, and find yourself a good EHR.

Now’s a good time to mention I think that if you do decide to go with TherapyNotes, you can get an extra month free by going to the affiliate link in the show notes. So check that out if you go with TherapyNotes.

If you haven’t subscribed to the podcast, I would love for you to do that. And if you haven’t rated or reviewed the podcast, I would also love to get some of those. So if you have a few minutes, feel free to rate, review, and subscribe to the podcast. And if you have any suggestions for improving the podcast or topics you’d want to hear, [01:05:00] drop me a line at jeremy@thetestingpsychologist.com.

All right, y’all. Stay tuned for more awesome content coming up in the next few weeks. Take care.

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