There are currently three major billing software products available for the Palm Pilot®: PocketBilling® by PocketMed; Pocket Patient Billing® by NES Software; and 1-Box® by e-360. Each program has individual strengths and weaknesses, and chosen properly should compliment and enhance point-of-care billing. As a software developer and practicing physician, I decided to try each for a week on our busy in-patient service during December 1999 and January 2000. Hopefully, this article will assist you in choosing the right product for your practice.
The first thing to be aware of when picking out your billing software is that all these programs are designed for in-patient billing, and are not currently programmed for the ambulatory setting (PocketMed is working on an ambulatory setting billing system to replace charge sheets). These programs essentially replace pre-printed cards or scraps of paper used to report encounters to coding clerks. While we were not able to test 1-Box, the differences between PocketBilling and Pocket Patient Billing were evaluated in a clinical setting.
PocketBillingPocketBilling has a very clean initial screen (Fig. 1) which fits on one Palm® screen, and allows access to name, last round date (automatically updated), medical record number, admit date (automatic or custom), allergies, diagnoses, medications, notes, visits, and discharge status. The allergies, diagnoses, and medications fields are pop-up boxes with up to 60 tap-and-pick selections (most common entries are already programmed), and are fully customizable.
PocketBilling is designed by a Family Physician. The program contains codes for initial and subsequent in-patient visits (including consultations), emergency room and nursing home encounters (Fig. 2). The codes are nicely organized by sub-categories so that you can easily find them by tapping on the appropriate sub-heading. Additionally, PocketBilling has procedure codes for most family practice procedures, including Obstetrics and GI E and M codes. All codes can be easily customized for any specialty.
Visits are coded by tapping on the appropriate sub-category, which will bring you to one of the screens shown below (Figs 3-7). Tap your stylus on the correct service, and presto, the service and date are automatically linked to the patient's full demographic information.
All of these screens are easily customizable to your practice. The most common codes are pre-entered. Also, PocketMed sends updated CPT codes annually with the purchase of PocketBilling.
PocketMed has limited written data entry to only 2 fields (name, and medical record number), allowing for easy pick-and-tap entry of all other data. They have also decreased information so that it can be viewed on one Palm® screen, which minimizes scrolling time and data entry time.
PocketMed's True-Practice evaluation of the software has shown that it is easily learned with minimal instruction (even for computer-illiterate physicians), and that it can actually increase total inpatient revenues, inpatient charges per visit, and accelerate the accounts-receivable cycle. Data transfer is either by Hot-Synching®, printing to infrared-equipped printers (using PalmPrint® from Stevens Creek Software), or via memopad printouts. Patient data can also be beamed or e-mailed to colleagues for check-out. PocketBilling does not include a desktop version at this time (although it is currently in development), and must be run with HanDBase®. Desktop data entry and synchronization can be done with HanDDesk® and Microsoft Excel or with HanDJet®.
PocketBilling ran smoothly and no bugs or crashes occurred. It is intuitive, fast and easy to use. PocketMed offers telephone and e-mail technical support, and has a 30-day money back guarantee. It is the least expensive of the three programs at $29.99 per licensed copy (price does not include HanDBase®, currently $20 per licensed copy).
Pocket Patient BillingPocket Patient Billing is another very nice palm application which runs on the HanDBase platform. This program includes HanDBase and a desktop application based on Microsoft's Access 97 or 2000. The physician behind Pocket Patient Billing is a specialist in nephrology, and the program favors specialists (i.e. in the pre-programmed codes and procedures), although it is easily customizable.
The initial screen (Figs. 8-10) includes the following demographics: name; discharge status; hospital unit and room; linked databases for charges and diagnosis; and rounding status. As you scroll down the initial screen, there is room to enter date of birth, medical record number, referring MD, a problem list, a "to-do" list, a miscellaneous field, and three user-defined fields.
When you tap on "charges" in Patient Pocket Billing you link to a database (Fig. 11) that includes the date the record is added, a link to CPT codes, a miscellaneous notes field, a "printed" checkbox, and a link to diagnoses for that visit.
After tapping on the CPT code, Patient Pocket Billing takes you to an all-inclusive database that includes approximately 80 codes. Because this program includes all CPT codes in one database, prolonged scrolling is a limitation. However, this database can be customized to show codes by category (i.e. if you wanted to display only the CPT codes for Consultations, you can). According to the developer, the upcoming version 3.0 will have all the > 8,000 CPT codes and > 15,000 ICD9 Codes. Also, the procedures codes were limited, although new ones can be added by users. The diagnoses fields linked to a freeware ICD9 database that was slow to search. This database can also be broken down by categories to minimize search time.
Patient Pocket Billing comes with a Microsoft Access database for PC-based data entry. The reports that could be printed off were very readable and easy to understand by my coding clerks. These were also customizable for users familiar with the Access program. The Access database didn't fully synchronize with the Palm Pilot, but you could either overwrite PC to Palm, or Palm to PC. Look for future editions to harness the Palm's full synchronization feature.
For physicians interested in more advanced desktop and reporting capabilities, this may be the program for you. NES software offers full technical support and a 30-day money back guarantee. The cost for Patient Pocket Billing is $129.00, which includes a run-time version of Microsoft's Access, and HanDBase.
1-BoxThe final billing software available was not actually tested in a practice environment by the author. It is billed as being a truly integrated, comprehensive information management solution designed specifically to give practicing physicians access to their data when out-of-the-office. It has a desktop application, and the premium version, 1-Box Connected, allows downloading of patients directly from practice management software (you need to contact 1-Box for pricing). According to e-360, the practice management interface is customized for each practice, and pricing is determined based on the workload for the connected version. As we did not test this program, one concern might be the memory taken up by storing all patients on the Palm Pilot. According to the manufacturer, 5000 patients can be stored on a PalmIIIx, and 15,000 patients can be stored on a Palm Vx, but this may not leave any additional space for your favorite applications. 1-Box offers full technical support and the downloadable version of this software is $399.