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Taking My Private Practice “Paperless”

By Jessica Lang Kosa, PhD, IBCLC

Going Paperless means no more of THIS!

Going Paperless means no more of THIS!

I’m writing this in the YMCA lobby while my daughter is in swim class. As an independent IBCLC working in a solo private practice and the mother of three, I need to use these little chunks of time. This was one of my main goals when I decided to change my practice to a “paperless” one. Being “paperless” means that all of my charting, records, communications, and care plans are recorded on one of my electronic devices. I have an hour while she swims. I have emails from clients with questions. I want to check their records before responding to them, even if it’s just to make sure I know the baby’s name and age. Having a paperless practice gives me access to my records via my phone or ipad.

One of the strongest reasons for making this switch was the need to combine emails with the rest of my client records. Nearly all of my clients do email me at some point, and I wanted to integrate a record of those communications in the client’s chart. Printing out emails and stapling them to the consult report seemed tedious and
wasteful. Making the whole record electronic solved that problem.

Other IBCLCs may consider going paperless for many reasons – avoiding paper waste,
saving storage space, and ease of communication with clients and other providers are
also benefits. I’ve also seen many different ways of approaching a paperless practice.
Here I’ll describe my system, not to suggest this is the correct or best way, but to offer it
up for others to improve on.

The first step is having the clients fill out my online intake form and sign my consent form. For this, I use Formsite – I already had an account because I use it for registration for my breastfeeding classes. It’s web-based, so it can be used by anyone, regardless of what type of computer they have. An alternative would be to have an intake form built into your website but, for many, any changes would require having to pay to have updates made by the person who runs your website. Formsite has a secure server feature, allowing for HIPAA-compliant collection of protected information. These features required a paid account on Formsite, but you can get a basic account for free to try it out.

Building my intake form using their interface was time consuming, but not difficult. It allows you to drag and drop questions of different types (checkbox, multiple choice, text answer, date) as well as arrange and format them. I built my consent form and HIPAA notice in as well. When a client makes an appointment, I give her the link and password to access the form. (If she didn’t have internet, I’d go back to a paper form, but it’s only happened once.) When she fills it out, the site sends me an email notification. I log into Formsite and download the info as a spreadsheet. Then begins the fun.

I paste the spreadsheet including the intake info into an app called Bento. This is a Mac based program – if you have a PC, you would paste it into Excel or whatever spreadsheet
program you like. I chose Bento because it was the only app I found that would combine
emails, spreadsheet data, photos, and files all together. Now, when a client emails to
say the baby is up to 8 lbs., I can drag the email into her record in Bento. If she sends
me a picture, ditto. And her care plan and pediatrician’s report will be in there too.

At the actual consult, I use Bento on an ipad. It syncs with my home computer.
Important note – it syncs over my own home network, not through the cloud. The question of HIPAA compliance and the cloud remains formally unanswered, so I felt it behooves me to keep clinical info out of the cloud. (Yes, unencrypted email is also a potential HIPAA concern, so I address that in my consent form. And I don’t text with clients at all, except about scheduling.)

Bento allows me to create forms on my ipad to visually organize info. I have one form
that shows the intake info she gave me online, one with her doctors’ contact info, one
for the evaluation I do at the consult, one for followup info, and one for my superbill. I
use checkboxes and dropdown menus as much as possible so that I spend minimal
time typing. I complete the evaluation form as I go along, during the consult. At the
end, I complete the superbill, which I will export as a PDF file to send her. The followup
form will contain her care plan and report (as PDF files), emails, notes on phone calls,
or any subsequent visits. The providers’ form is linked to a database of doctors, so I
can easily look up their phone or fax numbers.

Another nice aspect of this – by using checkboxes, I can easily quantify data across my
whole practice, such as what percentage of babies I referred for tongue tie.

I could create Bento forms for my reports and care plans, but I haven’t. Bento doesn’t
allow for a lot of formatting, and I like them to be in letter form, so I do those separately
using Pages (Mac’s word processor.) I save the care plan and report as PDF file. I
email the care plan to the client, along with her superbill and any handouts or additional
info I want to send her, and I use PamFax (there are many other choices for online
faxing) to fax the report to the pediatrician and OB/GYN.

With all-electronic records, backup is critical. I use Carbonite for remote backup (if my house burns down, or my computer is stolen), and Time Machine for easy local backup (if my computer freaks out.) Both of these happen automatically.

All of this takes some investment of time to get up and running, but I’ve definitely found
that it makes my practice run more smoothly.

JLKJessica Lang Kosa is an International Board Certified Lactation Consultant in private practice in the Boston area.  She offers home visits for comprehensive breastfeeding help, and teaches courses in breastfeeding support for professionals who work with mothers and babies.


How IBCLCs Can Make an Impact Through Social Media

Written by Robin Kaplan, M.Ed., IBCLC

With 93% of adults born after 1982 (the Millennial Generation) communicating online and nearly 3 out of 4 using social networking websites, such as Facebook and Twitter, breastfeeding promotion and support has been taken to an entirely new level. In the Journal of Human Lactation article, Establishing an Online and Social Media Presence for Your IBCLC Practice, authors Amber D. McCann and Jeanette E. McCulloch, present findings that encourage all of us in the breastfeeding community to step into the minds of these Millennial mothers and engage with them about breastfeeding in their preferred medium.

Why does breastfeeding promotion and support need a social media presence?

While health care providers continue to be the first choice for most people with health concerns, 80% of US Internet users have sought health advice online.  Plus, 44% of US women spend more time online after a new baby is born.  We live in an amazing time where we can find answers online in an instant when we used to have to wait until our doctor’s office opened the next morning.  The scary side of this is that there is so much misinformation online about breastfeeding and how easy it is for mothers to access this incorrect advice. Even formula companies have breastfeeding advice sections on their websites… this is NOT where new mothers should be receiving their evidence-based breastfeeding information and support….right next to a Enfamil advertisement!

Also, with breastfeeding being such a HOT TOPIC in the news, mothers are often bombarded with this negative press.  It goes viral in an instant!  The Time Magazine article, ‘Are You Mom Enough‘ and Mayor Bloomberg’s initiative to ban the formula bags in all New York City hospitals flooded the Internet and social media networks in record time.  Negative comments about breastfeeding were abundant!  While Best for Babes and Kellymom are doing all they can to turn this bad breastfeeding press into something positive, they need our help to further provide breastfeeding education and support online.

So where are these Millennial mothers and what are they doing online?

The four most dominant social media platforms are Facebook, Twitter, blogs, and Pinterest. What these platforms have in common is that they ALL promote engagement among Internet users.  This is not like reading a book for information, which is a one-sided conversation.  Using social media allows you the ability to comment, ask questions, and agree/disagree with the author and other commenters.  It’s a conversation.  When a mother posts a question on a Facebook page, she is actively seeking advice from her peers or an ‘expert.’  When a mom reads a blog article, she is looking to make connections with the author to help make sense of her world and often seek advice on a particular topic.  Twitter is all about conversation and engagement and Pinterest is now a hub for articles and driving more traffic to websites than Facebook.  We may not live in a village anymore, but the Internet is revitalizing the village mentality.  It’s all about the need for support and belonging.

How can an IBCLC use social media effectively, without feeling like it is a waste of his/her time?

  • Creating a social media plan can be extremely helpful or you might find yourself being led down the time-sucking social media rabbit hole.  As McCann and McCulloch suggest, create a plan that is appropriate for the size of your business or organization.
  • Decide who your target audience is and the purpose of your engagement.
  • Choose a social media platform or two that you feel is manageable and decide how much time you plan to dedicate to it a week.
  • Spend some time just watching and listening.  You will figure out pretty easily what your audience is looking for.
  • Keep in mind that social media is all about sharing information. While you don’t want to give away everything you know, the more information you benevolently share online, the more appreciative your audience will be and encouraged to return to your platform in the future.  You may have the chance to influence the greater masses with your positive messages about breastfeeding!

What about ethical concerns and client/patient confidentiality?

McCann and McCulloch stress the importance of upholding our Code of Professional Conduct, Scope of Practice, and Standards of Practice.  The authors state that while these documents ‘do not contain a specific social media policy, IBCLCs may want to review the American Medical Association’s Policy on Professionalism in the Use of Social Media’.

As an avid blogger and social media user, I have a phrase that I use very regularly when I receive a comment or question that takes information from general breastfeeding advice to specific for one mom and baby and it goes something like this…. “It definitely sounds like you have some very important questions that would be best answered in a private conversation with an IBCLC.  If you would like to discuss this further, please contact me at …..”   This lets the mother know that I would love to help her, but this is not the appropriate place to discuss private, personal information and I want to protect her privacy.

So, even if you feel like you are not Internet savvy and social media gives you hives, all you have to do is start off slowly.  Lurk a little on these social media platforms and just listen to what mothers are saying and asking for.  Check out the Lactation Matters article, Great Breastfeeding Blogs to Read, and start sharing these articles on a social media platform.  Begin a conversation on a Business Facebook page and see where it takes you.  My guess is that you quickly see your calling to offer breastfeeding-supportive and evidence-based guidance to our Millennial mothers.  And you never know… you might just have a ton of fun, as well!

Robin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding Co-editor of theInternational Lactation Consultant Association’s (ILCA)blog, Lactation Matters, and a regular contributor toILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show and the Director of Marketing for  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.


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