Healthcare administration

The referrer is the business

In a great deal of private healthcare the patient did not choose you, somebody sent them. A general practitioner, a consultant, a physiotherapist, an employer, an insurer, a case manager. That relationship is the reason the practice has work, and it is almost never recorded as anything at all.

The consequence is that a practice cannot answer basic questions about its own income. Which referrers send the most. Which have stopped. Whether the drop in January was a market change or one consultant retiring. Everyone has an impression and no one has a number.

A referrer as a relationship, connected to every person they referred, turns that into arithmetic. It also makes a drop visible: a referrer who sent you six people a quarter and has sent none for two is a telephone call worth making, and it is a telephone call nobody makes because no one notices.

The permission model has to be two decisions

Reception books appointments, takes payment and answers the telephone. They need the system. They frequently should not be reading clinical correspondence. In a product with one permission level per person, those two facts are in direct conflict, and the resolution is either that reception sees everything or that reception cannot work.

Splitting it into two decisions is what resolves it. The role says what somebody can do: book, reschedule, take payment, raise an invoice. Sensitivity is a separate grant that says which restricted records they may open. Somebody can have full ability to run the front desk and no access to a restricted record, and the restricted record does not appear in their search as a locked row confirming it exists, because in this trade the existence of the record can itself be the sensitive fact.

Consent is not one thing

An appointment reminder is not marketing. A recall is not a newsletter. A practice that treats consent as a single switch ends up with two bad outcomes at once: people who asked not to receive marketing stop receiving reminders, and people who wanted reminders receive a newsletter and complain.

Consent per channel, held as a fact with a date and a source and checked again at the moment of sending, is what separates them properly. It also produces the evidence you will want if anyone ever asks what someone had agreed to at the time, which a single current value field cannot answer.

We will not tell you it is compliant

Compliance is a property of your practice rather than of a piece of software, and any supplier telling a healthcare provider otherwise should be treated with suspicion. What we will do is describe accurately what the product does, where data is held, who can see it and what evidence exists, so that your data protection officer can reach their own conclusion.

Data is not held in the UK

The European Union or the United States, chosen at creation and fixed from then on. UK practices should choose the European Union. If your requirement is specifically UK residency, we do not meet it today, and that is a better thing to learn from this page than from a procurement questionnaire.

What we do not have

No SOC 2 and no ISO 27001. No published penetration test. No integration with any clinical system today. No SMS sending. The security page carries the full list, including two protections that are built and not yet enabled in production, because a sector doing diligence deserves the unflattering half of the picture as well.

What to check before you commit

Run an export on the first afternoon, before there is anything in it that matters. It is free on every plan and produces everything you hold in a format that opens without our software. Knowing it works is worth more than any assurance on a page like this one, and the rest of the questions worth putting to any supplier are written down rather than left for you to think of under time pressure.

The insurer, who is paying and is never the patient

The insurer is an organisation, connected to the people whose treatment it funds, with the policy details on the connection. What that arrangement makes possible is the ordinary awkward moment at the desk. A course of treatment is authorised for a set number of sessions, the patient arrives for one more than that, and whoever is on reception has to know whether it is covered before the appointment rather than six weeks later when the invoice comes back.

An authorisation reference and the number of sessions it covers, held where reception can see them without seeing anything clinical, turns an invoice dispute into a conversation at the desk. It is a small piece of information in an unglamorous place and it is one of the few administrative facts in this trade with a direct price on it.

The employer, who is entitled to an outcome and not to a record

In occupational health and in employer funded treatment the payer is a company, and the company is entitled to considerably less than it usually expects. Somebody in human resources will ring and ask how their employee got on, and the correct answer is attendance, an outcome, and whatever report they are contracted to receive. Nothing else.

This is the relationship where the permission model earns its keep most obviously. The employer sits on the record as the payer, connected to the person whose treatment it funds. If the clinical correspondence is one click from that connection and visible to whoever picks up the telephone, the wrong answer is the easy answer, and the wrong answer here is a disclosure instead of a mistake.

The solicitor and the case manager, where the patient is not the client

Medicolegal and rehabilitation work invert the usual arrangement. The instruction comes from a solicitor or a case manager, the report goes to them, the deadline is theirs, and the person being examined is the subject rather than the customer. A practice that models this the ordinary way, with the patient at the centre and the solicitor as a note, loses track of the only relationship that produces more work.

Model the instructing firm as the organisation, the individual solicitor or case manager as the person you actually deal with, and the person examined connected to both. Then the question nobody in this kind of practice can currently answer, which instructing firms send work and which have quietly stopped, becomes exactly the same arithmetic as the referrer question at the top of this page.

The care home, the school and the household, where whoever rings keeps changing

Some patients are booked by someone else every single time, and that someone else changes. A care home has staff turnover and a deputy manager who rings for six months and then does not. A school has a designated member of staff for this year. A household has one adult who books for four people.

The durable thing is the home, the school or the household. The person who rings is a connection with a period on it. Holding it the other way round, as a contact record with the home's telephone number typed into it, loses the history the first time a manager leaves and leaves the practice ringing a number that reaches someone who has never heard of the patient.

Next of kin, and the gap between authority and concern

Two different roles arrive in the same telephone call and they are not the same record. A parent of a child, an attorney, a court appointed deputy: these hold authority. A worried son holds concern. Both are worth recording. Only one of them can be guessed at the desk without consequence, and it is not authority.

Record the relationship as what it actually is, and put any contact restriction where whoever answers the telephone sees it before they say anything. Do not leave a message on this number. Do not write to the home address. Do not discuss the appointment with the person who books it. In this trade those are safety instructions rather than preferences, and they belong at the top of a record rather than in the fourth note down where someone in a hurry will not reach them.

The interpreter, and the room on the ground floor

Language and accessibility requirements are administrative facts with booking consequences. An interpreter has to be arranged in advance and a ground floor room may have to be held. Reception needs both at the moment of booking, neither is clinical, and a practice that discovers them on the day loses the appointment and the goodwill in one go. These belong in the small set of custom fields rather than in free text where they are found by accident.

Several of those parties keep records of their own at the other end of the same relationship: solicitors and law firms, who instruct the medicolegal work, professional services firms, who count referrals the same way, and training providers and schools, where one member of staff books on behalf of everyone else. How a role and the separate sensitivity grant are actually set is on administration and permissions.

The practice whose management suite already holds the administration

Several disciplines have a practice management product that carries the clinical record, the diary, the invoices and a serviceable contact list in one place. If you have one and you are broadly content with it, adding a second system means every patient exists twice, and the second copy is wrong within a month unless somebody is paid to keep the two level.

The case for a separate administrative system is strongest when the referrer question and the enquiry question cannot be answered at all. It is weakest when they are already answered adequately, and adequate is a perfectly good place to leave something.

The practice that wants patients booking themselves

There is no patient record, and no portal that shows one. A patient can book a slot on a published booking page and can fill in a web form, and on the plans carrying the portal somebody outside can sign in to see the enquiries they raised. What none of them can do is reschedule, read a letter, or see anything clinical. If self service around a clinical record is the thing you are buying, a patient system is the thing to buy, and bolting one alongside a CRM produces two records that disagree.

The practice whose whole problem is the text message

Consonas does not send SMS today. That is in the questions below and it is repeated here because it is the most common single reason a practice in this trade should buy something else. If missed appointments are the thing keeping the owner awake and reminders by text message are the intervention, buy the reminder product. It will cost less than this and it will solve the actual problem, which is a better outcome than a general system that solves an adjacent one.

The practice that needs it to talk to the clinical system this year

There is no integration with any clinical system today. A patient created in one is not created in the other, so somebody types twice or imports periodically. In a practice of three people that is an irritation. In a busier one it is a job, and a job that needs an owner and a habit rather than good intentions. If double entry is unacceptable to you, that is a reason to wait or to buy elsewhere, and it is much better learned now than in the third week.

The practice with UK residency written into a contract

The European Union or the United States, chosen when the organisation is created and fixed from then on. UK practices with no specific residency clause should choose the European Union. Practices whose commissioner, insurer or corporate client has written UK residency into the contract should stop at this paragraph, because nothing further down the page changes it.

The practice where a certificate is the gate rather than the evidence

Some buyers, particularly where a public body or a large insurer sits behind the contract, treat certification as a threshold to be met rather than as one piece of evidence among several. There is no SOC 2, no ISO 27001 and no published penetration test. Where the certificate is the gate, we do not get through it, and describing the audit trail in more detail does not change the answer.

Who that leaves

A practice of a handful of people where no one can say which referrers produce the work, where the recall list is a spreadsheet one person maintains, where the enquiry that did not convert left no trace, and where the front desk can either see everything or do very little. That practice is the one this page was written for. Everyone in the six paragraphs above is better served by something else, and we would rather write that down than find out during a trial.