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Case Study: A Custom EHR System


A psychiatry and psychotherapy practice of 85 doctors had used four different EHR/Practice Management Systems over the last 10 years, but each system had specific problems and mismatches with the ways that the practice was caring for patients and doing business. As the number of clinicians and support staff in the practice grew, standard off-the-shelf medical records and billing solutions could no longer fully meet their specific needs. The clinic was developing work-arounds that required multiple new employees to deal with these problems. They were reluctant to take on the expense of building and maintaining their own medical records and practice management software from scratch. Some of the key issues they were facing were:

  • Session Coding: Clinicians were not coding claims consistently, and the clinic’s coding rules varied with insurance contracts. As the number of encounters increased, so did the number of mistakes and the clinic was losing money because of coding problems. The clinic wanted an auditable way to automatically code psychiatry and psychotherapy sessions based on the progress note itself.
  • Supervising: When new clinicians came on board, they needed to be supervised and their notes signed by a supervisor. The clinic needed a way to create communication between supervisees and supervisors and to facilitate supervisory signatures on progress notes and in billing.
  • Online Scheduling: The clinic had multiple scheduling needs that could not be met by traditional scheduling software. The bulk of their patients needed to register and schedule sessions online and many of these were telemedicine visits. In order to schedule, patients would need to find openings across many doctors in different clinic locations for different types of sessions. In addition, doctors were paid on salary and the scheduling system needed to maximize clinician schedules while also providing a simple interface for patients and internal staff to schedule sessions.
  • User Interface Complexity: The EHR systems they had been using were not designed for the specific needs of psychiatry and psychotherapy. They were too clunky and the user interfaces were bloated. The clinic wanted a streamlined, simple user interface to help clinicians schedule and chart without having access to parts of the system that they shouldn’t see. Furthermore, the clinic wanted to give doctors up to date information about their productivity and income in an easy to use way.

Our Response

Crystal Bay Software used its own enterprise-ready cloud-based medical records and billing software as a base to customize the software for this client’s specific needs. Since we were able to use an already existing and proven medical records and practice management program to start with, we were able to make a series of changes to the program to customize it for this client’s specific needs.

  • We built a custom coding module which automatically coded sessions based on the clinician progress notes and the clinic’s specific insurance contracts. The result was that the clinic no longer needed a person to review and approve session coding.
  • We built a custom supervisory interface into the medical records program which would allow supervisors and supervisees to communicate and sign off on notes.
  • We customized scheduling for the specific needs of the client creating a template-based scheduling system tailored to their own needs.
  • We simplified the entire medical records system to contain only what the practice needed in order to make the doctor interface easy to use. This also included separating billing and administrative responsibilities from those of the clinicians.
  • Crystal Bay maintained the system in the cloud so the client didn’t have to deal with technical issues. We responded to technical support questions as needed.

The Result

  • The practice was able to grow to 250 doctors over the following year with the ability to further extend their practice and systems and low cost.
  • The organization wasn’t burdened by supporting technology or maintaining it. Crystal Bay handled all of this.
  • Doctors in the practice were extremely happy about a simplified system and were able to see patients and chart notes much more quickly.
  • The clinic’s IT costs decreased compared to previous systems.
  • The clinic owners were relieved that their systems could easily be modified and changed as their needs changed.
  • As the practice grew and wanted more changes, Crystal Bay was able to quickly make those changes for the organization.

Crystal Bay Software's Enterprise-Ready EHR and Billing systems can be quickly customized to your organization's needs. Contact us for a demonstration!
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