By Jessica Lang Kosa, PhD, IBCLC
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.
Jessica 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.