Introduction

Ambulatory facilities face unique challenges when it comes to selecting medical software and systems. Choosing the best ambulatory software for your practice takes time; with hundreds of options it can be difficult to determine which system best fits your needs and budget.

Ambulatory care is a growing segment of the greater U.S. healthcare marketplace, especially outpatient centers such as ambulatory surgery centers (ASCs), urgent care, and satellite emergency departments.1 While many of these facilities are owned by — or at the very least are affiliated with — a hospital or hospital group, a substantial number are not; despite the trend towards consolidation in the U.S. healthcare market, the vast majority of patient appointments still happen at a private practice — over 88 percent.

This guide will help introduce the three main types of ambulatory software, a list of market-leading vendors within each subset, current trends in ambulatory software, and a case study of a popular ambulatory software solution.

Types of Ambulatory Software

Ambulatory software is a nebulous term — it can encompass many different electronic systems used within an ambulatory care setting, including simple word processing software or an email client. For the purposes of this guide, we will limit the discussion to the most used software systems to manage ambulatory workflows, ambulatory patients, and ambulatory billing.

Ambulatory EHR / EMR

At the core of most ambulatory software is the electronic health record (EHR). Initially designed to be a simple replacement for legacy paper charts, EHRs today serve as the central repository for all patient or care-related information, such as laboratory orders, progress notes, medication lists, etc. To learn more about EHR, see our comprehensive buyer’s guide to EHR software.

Market-Leading Ambulatory EHR Vendors

The following ambulatory software vendors all offer highly-rated ambulatory EHRs.Each of these vendors also offer pre-integrated practice management and patient portals, so you can build a holistic software environment supported by a single vendor.

Software Vendors: CureMD, eClinicalWorks, iSalus, athenaHealth, Meditouch, Allscripts


Ambulatory Practice Management (PM)

While the EHR may be the central repository for all clinical information and processes, practice management systems serve as the repository for all administrative information and functions at your practice, such as patient registration, appointment scheduling, workflow management, etc. For many physicians’ offices, practice management systems are also the primary billing interface. To learn more about practice management systems, see our comprehensive buyer’s guide to practice management software.

Market-Leading Ambulatory Practice Management Software

The following software vendors offer practice management systems designed for ambulatory or private practice settings. Each of these vendors also offer pre-integrated EHR and patient portal software, so you can build a holistic software environment supported by a single vendor.

Software Vendors: Kareo, athenaHealth, AdvancedMD, Care360


Ambulatory Patient Portal

An increasingly important part of any ambulatory software environment is robust patient portal software. At many ambulatory facilities, the patient portal serves as the primary method of electronic communication between patients and providers. Patients can use portals to request appointments or prescription refills, view lab results, or securely message their physician with questions or concerns. Increasingly these systems are including more innovative features such as online bill pay or automated appointment reminders. To learn more about patient portal software, see our comprehensive buyer’s guide to patient portal software.

The following software vendors offer standalone patient portal software designed for ambulatory or private practice:

Software Vendors: Bridge Patient Portal, Solutionreach, Updox


Ambulatory Medical Billing

Though many ambulatory facilities rely on their practice management solution for their medical billing processes, standalone medical billing software is still used by a large number of providers to submit insurance or Medicare/Medicaid claims and manage accounts receivable electronically. Additionally, some ambulatory facilities outsource their revenue cycle management entirely, instead contracting with a third-party billing and coding services provider; these services usually require the use of a standalone medical billing system that they can access remotely. To learn more about medical billing software, see our comprehensive buyer’s guide to medical billing software.

The following software vendors offer medical billing software suitable for ambulatory facilities. Some are billing-only solutions, but the majority offer multiple ambulatory software tools, including EHR/EMR and practice management systems.

Software Vendors: Iridium Suite, Mercury Medical, Medical Mastermind, NueMD

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Ambulatory Software Case Study

Company: Raritan Family Healthcare3

Solution: Cerner

Raritan Family Healthcare (RFH), a five provider family practice clinic in Raritan, N.J., adopted Cerner’s Ambulatory EHR, e-prescribe, and Specialty Practice Managment (SPM) software in June of 2008. Within ten months the practice realized 100 percent return on investment. Dr. Joseph Scalia, one of Raritan’s physicians, said the EHR solution has saved the practice between $300–$500 a month in paper chart supplies, and has enabled RFH to reduce its full time staff by five.

“Our payroll is down 10 percent and maybe a little more. We were at 42 employees and now we are at 37. The system has already paid for itself.” — Dr. Joseph Scalia

During the first week of implementation, Raritan adjusted its patient load to allow office staff time to adapt to the new system. According to Dr. Scalia, the clinic saw one to two patients per hour when the EHR was initially implemented, but within a week, the practice was back to its full schedule.

Since the rollout, one of the main benefits to RFH has been the time savings from e-prescribing:

“Prior to e-prescribe, we had one person who solely made phone calls to pharmacies on prescription refills. With e-prescribe, we no longer need a person dedicated to calling pharmacies, so that has saved us eight hours a day.” — Dr. Joseph Scalia

Patients love e-prescribe, says Dr. Scalia, because the pharmacy can start filling an electronic prescription before the patient arrives — so there’s no waiting.

Cerner’s Ambulatory EHR also allows clinicians to share pre-completed notes with each other. Dr. Scalia says this helps him get ideas from his colleagues on how to document within the EHR. Pre-completed notes save RFH 1.5–2 hours per day.

“We save three to five minutes per office visit with pre-completed notes.” — Dr. Joseph Scalia

Overall, staff and patients are impressed with the adoption of Cerner Ambulatory EHR; according to Scalia, “Patients like the EHR because they have more confidence in our office as we use better documentation technology.” Finally, Dr. Scalia says “an added bonus with Cerner’s EHR is that we have a much cleaner and less cluttered office because no paper charts are hanging around.”

Comparing Ambulatory Software

When you compare ambulatory software solutions there are a number of factors to consider. One of the first decisions you’ll need to make is whether or not you’ll use a cloud-based system or one deployed on a local server. Both options have benefits and drawbacks:

  • Cloud-based Ambulatory Software offers a number of advantages when compared to comparable on-premise platforms. First and foremost, the up-front costs are far less, as you won’t need an on-site server, just a web-connected workstation or mobile device. Of course, the monthly or annual subscription fee means that typically the total cost of ownership of cloud-based systems is higher than that of many on-premise systems, but if there are implementation fees, they’re usually much less than those for similar on-premise platforms. Finally — and perhaps most importantly — protected health information is stored on the vendor’s (or third-party hosting provider) servers, meaning they’re the ones most often held liable for HIPAA-related breaches of security.
  • On-premise Ambulatory Software is installed to a local server or computer. This deployment option allows you to have more control of your software environment, but the up-front costs for hardware and licensing are usually significant. Also, while some ambulatory software**vendorsinclude updates to the software as part of their licensing agreements, many do not, which could mean you’ll be stuck with a hefty upgrade fee if you want to upgrade to the latest version when it is released. Also, since the protected health information (PHI) will be stored in an on-site server, the responsibility for data security falls solely on your practice.

Another decision that must be made when choosing ambulatory software is whether or not you’d like a modular ambulatory software solution or an all-in-one ambulatory software system. As with cloud versus on-premise, there are a number of benefits and drawbacks to each type of solution.

  • All-in-One Ambulatory Software is pre-integrated, so interoperability between PM, EHR, and billing systems won’t be an issue, and there usually won’t be any need for duplicative data entry. Another benefit is that with an all-in-one system, you have a single point of contact for support. The vendor can’t say “oh that’s the competing platform’s fault — if you used ours it would work.” Also, most all-in-one systems have a (usually) lower total cost of ownership.
  • Modular Ambulatory Software allows you to pick and choose only the features and/or functionality you need. Already have a PM system you like? Just buy an EHR. Already have an EHR you like, but need a patient portal? Just buy the patient portal. While it usually takes more work — and custom software development — to properly integrate systems from disparate vendors, modular ambulatory software allows for a truly custom software environment. Another potential drawback is that comprehensive (i.e. buying every module offered) modular systems frequently have a higher total cost of ownership compared to a similar all-in-one system.

Last but not least, you’ll need to decide whether or not you want a generic, specialty-agnostic software solution or one tailored for your specific specialty. If you operate a multi-specialty ambulatory facility, a specialty-agnostic solution will likely be the best fit. In contrast, if you operate a single-specialty ambulatory clinic, a specialty-specific solution may be the best choice.

Choosing a Solution

That’s where we come in. Here at TechnologyAdvice, our goal is to help businesses by connecting them with the best technology solutions for their unique needs. We’ve compiled product information, user reviews, case studies, comprehensive feature lists and definitions, video walkthroughs, and original research on thousands of leading business technology products, all to make the buying process easier for decision-makers like you.

If you’d like to learn more about any of the ambulatory software solutions outlined in this guide, we’d love to talk to you. Call one of our in-house Technology Advisors today for a no-cost, no-obligation consultation on your unique needs, or use our Product Selection Tool for a list of personalized recommendations.

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Sources
  1. Ellis, James and Razavi, Aaron. “The Accelerating Growth of Ambulatory Care Facilities.” Healthcare Finance. October 1, 2012. http://www.healthcarefinancenews.com/blog/accelerating-growth-ambulatory-care-facilities
  2. “National Ambulatory Medical Care Survey: 2010 Summary Tables” Centers for Disease Control. Accessed June 10, 2015. http://www.cdc.gov/nchs/data/ahcd/namcs_summary/2010_namcs_web_tables.pdf
  3. “Cerner Ambulatory EHR Pays for Itself in Ten Months.” Cerner. Accessed June 10, 2015. https://www.cerner.com/uploadedFiles/Content/Solutions/Physician_Practices/Case_Studies/Raritan_casestudy2012.pdf
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