March 12th, 2007 by Dr. Bromberg
Dr. James W. Hull is a clinical psychologist in private practice in New York City. He is a member of the Personality Disorders Institute of the Weill Medical College of Cornell Univesity, and a former supervising psychologist at the Westchester Division of The New York-Presbyterian Hospital in White Plains, NY.
We met recently to talk about a system he has developed for the computerized management of his clinical practice. I believe that Dr. Hull on the cutting edge of what will be a more and more indispensible way of tracking and organizing appointments, documents, billing, and chart information for clinicans in almost every professional setting I can think of.
I am very pleased that Dr. Hull was willing to provide me with the first interview for the DrBromberg.com blog. I hope and trust that you will find his ideas to be interesting food for thought. For those who would like to learn more about “The (Almost) Paperless Practice” from Dr. Hull, I have included his contact information at the end of the interview.
Dr. Bromberg: You’ve developed something you call “The (Almost) Paperless Practice.” Can you describe what that is?
Dr. Hull: It’s a system that I have developed for myself, but that may be of interest to other clinicians, in which almost everything related to my practice is managed and stored electronically. I have almost no paper records for my practice at all.
Dr. Bromberg: You call it, rather than “The Paperless Practice,” “The (Almost) Paperless Practice.” How come?
Dr. Hull: There are certain kinds of paper you probably can never dispense with. For example, there are always going to be patients who want statements that they can submit to their insurance. And you’ll always get letters from patients that you want to save. Also, there are some kinds of paper you don’t want to dispense with, like checks for payment. But with a few exceptions like this, everything else is digital.
Dr. Bromberg: How did this develop?
Dr. Hull: When I decided to go into full time practice, I struggled to find a way of keeping records and organizing them in an efficient system. What I particularly wanted was a system that didn’t take me much time to manage. I practice in the city, so I ride the train every day, and I set as my goal that all of my practice record keeping should be able to be done on the train. And I’ve certainly come close to that.
Dr. Bromberg: What are the components of the system?
Dr. Hull: I think the minimum is to have a digital system to manage appointments, patient records, and payments, as well as a digital file cabinet for storing scanned images of every document that comes into my practice, and everything that I send out. These two components, the daily record system and the digital file cabinet, form the complete system.
Dr. Bromberg: So, what has it been like for you to actually implement this?
Dr. Hull: I began in an effort to increase my efficiency and minimize the maintenance costs of running a practice. And then, as I got into it, I thought ‘This is really interesting.’ First of all, it’s something almost no one in our field does, but people in other fields do this sort of thing a lot. Your bank, for example, doesn’t keep any of your checks. They scan them and archive them digitally. And if banks can do it, the IRS must be on board. So it seems other fields are moving in this direction.
Dr. Bromberg: I’m curious about the potential benefit of this to other clinicians. You mentioned efficiency, for one.
Dr. Hull: Some clinicians, clearly, should not do this. If you run your practices out of a Filofax, use notebooks to take patient notes, and keep track of fees and payments using an account book, this probably isn’t for you. I think this is more of a system for somebody who is already using computers and is heavily into it, someone who sees and values the potential of unlimited, easily searchable archives. Imagine if every document, every phone call, every letter, every piece of paper you’ve ever gotten from a patient, or ever gave to a patient, was stored forever and was easily accessible. That’s really what this is about. And there’s an obvious advantage to that.
Dr. Bromberg: Practices include paper, letters, etc., but you’re choosing to store that information digitally. What becomes of the paper? Do you dispose of it?
Dr. Hull: It gets shredded immediately, except for IRS records. I keep those in both scanned and paper form.
Dr. Bromberg: It sounds very simple, but there must be complications.
Dr. Hull: Sure. I think this can be customized, depending on the clinicians needs and preferences. For example, I don’t like to carry a laptop, so I keep all of my day to day practice information on my phone, using Excel Mobile and Outlook Mobile. When I get home at night, I sync the phone with my desktop, then I move that data over into my practice software. It’s an extra step, but for me it’s worth it because I don’t have to carry a laptop.
Dr. Bromberg: Other aspects of running your practice generate paper: Rent, malpractice insurance, etc. Can you, using your system, also manage those parts of your business?
Dr. Hull: Yes. That’s exactly how I do it.
Dr. Bromberg: How do you guarantee the information on your hard drive is safe?
Dr. Hull: Well, that’s a very important question. What I do is, I have an external hard drive connected to my computer. The computer runs all the time, and every night at about 2 AM all documents are backed up to the external hard drive. So, I know, at least that if the hard drive fails, I’m not going to lose more than one day’s data. My external hard drive has a removable cartridge that holds 35 gigabytes. Once a month I put in a new cartridge and take the full one to a safe deposit box. So, worst case scenario, I can never lose more than a few weeks worth of data. I think that’s good enough.
Dr. Bromberg: There’s a parallel concern. There’s the physical safety of your data, and then, as a clinician in the field, there’s also the issue of HIPPA. I imagine that starting to run your practice digitally heightens some of those risks and concerns. How do you navigate the compliance requirements?
Dr. Hull: Not long ago, I went to one of the HIPPA compliance courses offered by the APA Insurance Trust, and they talked about this. What they were advising was entirely consistent with what I’m doing. It seems that the key think is to have the hardware physically protected and the data password protected, so that if somebody got to your computer, they couldn’t access your records. This is especially relevant to me, because I carry a lot of my data around with me on my phone. If I lose my phone and somebody finds it, they will not be able to access that information because of the password protection. Given these safeguards, I think this type of system is actually more secure than a paper-based system.
Dr. Bromberg: How much time does it take to set up this system?
Dr. Hull: Well, you have to acquire the hardware and the software. Then, depending on how computer literate the clinician is, I would say this is something most people could set up in a couple of weeks. Not working full time, but just working on it a little here and there. It’s not hard to do. You have to decide what your archives are going to look like, where you’re going to store files, things like that. There are decisions to be made along the way, but this isn’t rocket science.
Dr. Bromberg: I imagine the real moment of truth for somebody converting to this system is when they’re comfortable enough with their archives to actually start shredding their old paper records.
Dr. Hull: Yes, that’s the moment of truth. But it becomes an acquired taste. Pretty soon you can’t stand to not shred things.
Dr. Bromberg: In terms of keeping the system running, you’re really able to manage all your notes and bookkeeping and everything just on your train ride to and from the city?
Dr. Hull: I would say train ride to and from the city, and sometimes sitting down in the evening for ten minutes or so. I do all of my scanning on the weekend, and I never spend more than 30-45 minutes per week on this.
Dr. Bromberg: How long have you been doing this?
Dr. Hull: Five years.
Dr. Bromberg: You had said initially that you don’t know anybody else that’s doing this, and I can’t think of anybody I know who does this either, but as you’re describing what you do it sounds fairly intuitive. Why do you think other people haven’t put together some kind of system like this for themselves?
Dr. Hull: I don’t know many therapists who actually use a computerized system to record notes, do you? I mean, I know some. But it seems to be more the exception than the rule. I’m not sure why. It’s an interesting question. I think you probably have to have a taste for these things, and you have to enjoy doing it. It’s much easier for younger clinicians who grew up with computers. I think it’s a fair guess that this will be done more and more in the future.
Dr. Bromberg: Are there perhaps any disadvantages to doing this?
Dr. Hull: I think the big disadvantage is if you don’t attend to the security and backup you could get really badly stung. That’s the main disadvantage that I see. Like I said, maintaining it doesn’t take much time, setting it up is not hard. And there is a tremendous relief in knowing that if you ever need to access a document, you can.
Dr. Hull’s contact infomation is:
James W. Hull, Ph.D.
286 Madison Avenue, Penthouse
New York, NY 10016