Realities of Risk Management

Through the use of risk management, managers hope to identify, analyze, control, avoid, minimize, or eliminate the risks that can harm their company. There are many mistakes that are made in risk management and it is important for companies to be aware the them. One mistake is the use of poor governance. Having effective governance leads to openness and commitment which allows risk management to function effectively. If a company lacks leadership, it will undermine the risk management capabilities. It is important to have discipline when involved in risk taking, especially during times of rapid growth and favorable markets. There must be limits, checks and balances, and monitoring involved.

Another miscalculation that managers have is following the “herd mentality”. When a company has a large amount of activities, especially in the areas of mortgage brokers, lenders, mortgage insurers, investment bankers, and institutional investors, it is easier for a manager to ignore the risks. When one manager sees another manager disregarding risks, they might have the tendency to follow suit. In order to avoid this, everyone must be made aware of the company’s financial condition.

Misunderstanding the “if you can’t measure it, you can’t manage it” mindset can be a blunder in the waiting. Many managers use this mindset as an excuse so that they do not have to fully understand or acknowledge the risks involved. Another faux pas managers make is accepting a lack of transparency in high-risk areas. Many managers make decisions with a lack of information. It is important for managers to see the whole picture before they make decisions. Executive management must create risk awareness throughout every aspect of the business.

A huge oversight in some companies is when they do not integrate risk management with strategy setting and performance management. When forming a strategy, it is important to incorporate all the risks involved. If risks are left out, managers will be left with unrealistic strategic objectives. Thus, leading to a strategy that can deteriorate the company’s competitive position, cause problems in the changing business environment, and cause the business to lose value.

Another oversight that can have a drastic effect on managing risks is not involving the board in a timely manner. If a problem arises, the board should be notified as soon as possible and not after the fact. It is important to familiarize the board with the organizations risk profile.

There are many risks involved when running a business. Managers need to behave in a manner that will benefit their company and they need to understand the risks involved in the business and be able to approach them in a realistic manner.

Practice Management Software & EMR – Single Source or Best-of-Breed?


For some, electronic medical records (EMR), electronic health records (EHR) and personal health records (PHR) all mean different things. To others, they are one in the same. One thing is certain – we are living in the era when medicine is irreversibly making technology a vital component of record keeping, practice management and ultimately, patient care. From government initiatives and mandates to private payer incentive programs, the push is definitely on for doctors to embrace not only electronic claim submission through their practice management system (PMS), but also the adoption of electronic medical records systems.

Knowing that you’ll need to implement this type of software is one thing, figuring out which programs are best for you is an entirely different matter. If you do a little research, you will find that there are over 300 companies that market practice management software. Dig a little deeper and you’ll find that there is another 300 plus companies that say they have and EMR solution. To cloud the issue further, some vendors offer all-in-one or single source solutions while others stick to their niche and offer either a PMS or an EMR solution only (best-of-breed). Even if you find software vendors that you think are reputable and have good software, you usually have to choose between a single source and a best-of-breed solution.

In this article, I will discuss the benefits and disadvantages of both the single source and the best-of-breed approaches to procuring PMS and EMR packages. I’ll also explore another option I call the full integration approach.

A Single Source Solution

Although both PMS and EMR are meant to be used in the same doctor’s office, they have completely different functions. Practice management software typically handles the billing and scheduling while EMR packages are on the clinical side – assisting practitioners with note creation, storing patient charts electronically, managing test results, X-rays, etc. While both systems are used by different people with different job functions, they are both involved in managing the same business transaction: the patient encounter. Doesn’t it make sense for these two software systems to work together seamlessly, passing information back and forth as the patient wends his or her way through a doctor visit? The short answer: yes, absolutely.

One approach to getting your PMS and EMR programs to work together is to find one company that sells and supports both programs. Often bundled or sold as a suite, these single source solutions offer the promise of seamlessly integrating the office workflow. Other benefits can include having only one contract to sign and one point of contact for sales, service and support.

While more and more companies are announcing that they have a single source solution, there are downsides to this approach. The main problem is that appointment scheduling, billing and collecting money are completely different activities from the clinical side of the patient encounter. Most companies offering a complete PMS/EMR solution started life as either a practice management company or an electronic medical records company. As a consequence, their expertise is almost always heavily weighted towards either practice management or electronic medical records. Rarely will you find a company that can do both sides equally well. As a result, buying a PMS/EMR suite could run the risk of having to put up with a good EMR package and a mediocre or poor practice management package, or vice versa.

It is also worth noting that many single source solutions on the market today started life as two different applications from two different companies – then were brought under one roof as a result of an acquisition or merger. When considering a single source solution, find out if they were originally developed by the same company. While some products that have merged do a good job of integrating with each other, there are others out there that do not work as smoothly as they could.


Instead of looking to one company for both PMS and EMR software, another popular approach is the so-called best-of-breed approach. That is, finding the best vendor for each application.

On the EMR side, the clinical demands on a system can be radically different from specialty to specialty. For example, the need to track dosage regimens and patient progress over long periods of time by an oncology practice is completely different from the types of clinical support a family practice might need, which differs even more from the needs of an orthopedic surgeon. Because of this EMR specialization, many practices have opted to go with an EMR vendor that has a long history and extensive expertise in their particular specialty. They choose the best-of-breed for their specialty.

While EMR tends to cater to specific specialties, practice management tends to be a bit more generic. Most offices have similar needs for scheduling, billing and collections. That is not to say there aren’t many best-of-breed choices to be made with practice management. There are wide ranges in cost, complexity and technology. Some systems have been designed for single doctor offices while others are priced for very large groups and clinics. Practice management best-of-breed choices often come down to the extras: features beyond basic scheduling and billing, ease-of-use and the quality of service and support.

The main advantage to this best-of-breed approach is that you’re looking for the best products for both PMS and EMR. If you’ve done your homework, you’ll find outstanding products from companies that have extensive experience in your specialty. The sales and support staff are more likely to provide better assistance tailored to your practice needs.

One disadvantage of the best-of-breed approach might be that you’ll end up with practice management and electronic medical records systems that don’t communicate with each other, causing some tasks, patient demographics entry, check-in/check-out and procedure charges, to be duplicated.

Most reputable software houses in healthcare offer HL7 interfacing capability which can ensure that patient and appointment data are shared. Some even offer charge postings, and some check-in/out. Interfacing your products can bring a big boost to your practice, but the level of interfacing capabilities will vary greatly from vendor to vendor. Due to inherent limitations in some products, only a very basic level of interfacing might be possible. You will want to do some homework and make sure that at a very minimum, the interfaced systems can pass demographics, check-in/check-out and charges can be passed from the EMR back to the PMS billing system.

Full Integration Model

A third approach is emerging for PMS and EMR integration that can provide the benefits of both the single source and best-of-breed. This approach, which I’ll term full integration, is when best-of-breed PMS and EMR vendors partner and enhance their products so that they work seamlessly together. Many systems have been interfaced so that basic information such as check-in and patient demographics are passed from the practice management system to the EMR. A deeply integrated solution would include all of those typical interface functions plus much more. For example, systems can be deeply integrated to achieve the following benefits:

  • Improved Workflow Management – Going well beyond basic check-in/check-out functions, deeply integrated systems can share workflow messaging, tasks, procedure charges and provide a single point for login and authentication. For example, after seeing a patient, the nurse practitioner could send a message or task from the EMR screen to the front desk PMS screen.
  • Single Source Benefits – Similar to purchasing a complete system from a single vendor, companies that have successfully integrated their products can offer many of the advantages of the single source one-stop-shop. When considering the purchase of deeply integrated systems, you may have one point of contact for sales. Companies that have successfully partnered may also offer streamlined contracts and pricing, making it easier to understand your total investment.
  • Best-of-Breed Benefits – If two companies that are truly best-of-breed in their market partner to offer a deeply integrated product, you gain all of the benefits from the best-of-breed model while avoiding many of the disadvantages. If you’ve chosen your companies well, you’ll have a practice management company that has extensive experience in your type of specialty. It will excel in scheduling, billing, office workflow management, collections and more. On the EMR side, you’ll feel confident that the EMR vendor will have a track record with and know the proclivities of your specialty. When you call in for support, you will be more likely to reach people that have specialized experience and knowledge of your needs.


At this time, the market for PMS and EMR is still dominated by stand-alone applications that may or may not be best in their breed. Increasingly, vendors are feeling pressure to offer complete, turnkey solutions. As a result, companies are acquiring other companies in the hopes of providing complete solutions. Still others are opting to develop the parts they need to offer what they feel will be a complete solution. A few companies have realized the considerable expense and risk involved with acquisitions and development and have opted to partner with other solutions to fill out their product offering. If you can find companies that have partnered to provide a complete solution AND they are each best-in-breed AND are experienced in your specialty and type of practice, you might want to strongly consider going with the deeply integrated solution.