Practice management software: choosing it, and what it means for the fitout
The Australian systems for general practice, dental, allied health and veterinary, cloud against a server in the cupboard, what each choice costs, and the cabling, power and room decisions that have to be made before the walls close.
The short answer
Practice management software is the system the practice runs on: appointments, the clinical record, billing and Medicare claiming, recalls, reports. It is chosen late by most new practices, after the lease and often after the design (it is an item on the opening checklist and a line in the business plan), and that order costs money, because the choice decides whether the fitout needs a server room, how many data points each room gets, what the phones plug into, and whether a power failure stops the practice. This guide covers the Australian systems by discipline, the cloud-or-server decision, what it costs, and the four things to tell your fitout designer once you have decided.
Key points
- Choose the software before the services design, because the choice decides the cabling and whether you need a server room.
- GP: Best Practice, MedicalDirector and Zedmed dominate; allied health: Cliniko, Halaxy, Zanda; dental: Dental4Windows, Exact, Praktika; vet: ezyVet, RxWorks, VetLinkSQL.
- Cloud removes the server but not the network: every room still needs two data points and reliable internet, with a backup connection.
- Budget $8,000 plus $3,000 to $6,000 per room for IT fit-off, phones and software setup.
- Medicare claiming, My Health Record and secure messaging conformance are the non-negotiables for a medical system.
Practice management software is the system the practice runs on: appointments, the clinical record, billing and Medicare claiming, recalls, reports. It is chosen late by most new practices, after the lease and often after the design (it is an item on the opening checklist and a line in the business plan), and that order costs money, because the choice decides whether the fitout needs a server room, how many data points each room gets, what the phones plug into, and whether a power failure stops the practice. This guide covers the Australian systems by discipline, the cloud-or-server decision, what it costs, and the four things to tell your fitout designer once you have decided.
The systems, by discipline
General practice and specialists
Three systems carry most of Australian general practice. Best Practice (Bp Premier on a server, with a cloud product following) is the largest by installed base and the one most GPs have used somewhere. MedicalDirector has the long-standing Clinical and Pracsoft pair on a server and Helix in the cloud. Zedmed is cloud-hosted and pitched at practices of two to twenty practitioners that want no server. For specialists, Genie and Clinic to Cloud are the usual pair, with Genie's on-premise heritage and Gentu as its cloud sibling. All of them are on the Services Australia register for Medicare online claiming, which is the first check; the second is conformance with My Health Record, electronic prescribing and secure messaging, which the Australian Digital Health Agency lists.
Dental
Dental4Windows (D4W) and Exact (Software of Excellence) are the established on-premise pair, with Praktika, Core Practice and Dentally as the cloud options. Dental systems carry imaging integration (OPG, intraoral sensors, CBCT) that medical systems do not, and that integration is what usually decides the choice: check the imaging vendor's list before the software vendor's.
Allied health
Cliniko is the broad all-rounder for physiotherapy, chiropractic, podiatry and psychology, priced per practitioner per month. Halaxy is free at the core and charges for SMS, claiming and payments. Zanda (formerly Power Diary) sits between them. Nookal and Splose have followings in specific disciplines. All are cloud; none needs a server; the decision is mostly about Medicare and health-fund claiming, online bookings and the price at your practitioner count.
Optometry and veterinary
Optometry runs on Optomate, Sunix Vision and the retail-plus-clinical cloud systems, chosen mostly for the dispensing and health-fund claiming side. Veterinary practice runs on ezyVet and RxWorks in the cloud and VetLinkSQL on a server, with inventory and pathology integration the deciding features.
Cloud or a server in the cupboard
The on-premise systems keep the database on a server in the practice; the cloud systems keep it in the vendor's data centre and the practice reaches it over the internet. Ten years ago the choice was about features. Today the features are close and the choice is about three other things.
Cost and who looks after it. A server is a capital purchase, commonly $3,000 to $15,000 with its licences, and then an IT contractor to patch, back up and eventually replace it. Cloud is a subscription per practitioner or per practice, commonly $150 to $500 a month per user for the medical systems and $45 to $150 for allied health, with setup fees of $3,000 to $8,000 for a medical migration. Over five years the totals are closer than either camp admits; the difference is whether the practice wants to own a problem or rent a service.
What happens when something fails. A server practice keeps working when the internet drops and stops when the server does; a cloud practice is the reverse. Both failure modes are manageable, and both have to be designed for: a server needs an uninterruptible power supply, a cool ventilated cupboard and a tested backup; a cloud practice needs a second internet connection (a 4G or 5G failover router is cheap insurance) and a way to keep seeing patients for an hour without the record.
Privacy and records. Health records are sensitive information under the Privacy Act, and the Notifiable Data Breaches scheme applies to a practice of any size. The server in the cupboard is a practice's own responsibility; the cloud vendor's data centre, its Australian hosting and its breach history are questions to ask in writing. Neither is safer by default.
What the choice means for the fitout
This is the part nobody tells you until the walls are closed. Four decisions in the fitout follow from the software decision, and all four are cheap while the ceiling is open and expensive after.
- Data points. Every consulting room needs at least two, at the desk and at the couch side, whatever the system, because a cloud system is still a networked one and Wi-Fi is not a plan for a clinical record. Reception needs one per workstation plus printers, the treatment room needs two, and the waiting room needs one for the check-in kiosk you may add later. Cabled in a fitout: about $150 to $250 a point. Added after: several times that.
- The comms cupboard. A cloud practice needs a small one: the router, the failover, a switch, the phone system, the patch panel, on a wall in the back office with a power point and ventilation. A server practice needs a larger one with cooling, a UPS and a lockable door, and it is a room on the plan, not an afterthought in a cleaner's cupboard. Tell the designer which before the room count is fixed.
- Power. The server, the drug fridge, the vaccine fridge and the phone system want circuits that do not share with the sterilisers or the air conditioning, and the fridge circuits want an alarm. A dedicated circuit is a line on the electrical drawings; a tripped fridge is a week of vaccines.
- Phones. Almost every new practice now runs a hosted phone system over the same network, which is why the network has to be designed for voice as well as data, with a switch that powers the handsets. Copper phone lines are gone; make sure the lease's telco access is real, and check the building has NBN or a fibre alternative before you sign, because a cloud practice on a poor connection is a slow practice.
Budget for all of this as one line: about $8,000 for the base network, phones and setup, plus $3,000 to $6,000 a room. The estimator carries it, and it is the line most builders' quotes exclude because the cabling contractor is usually yours, not theirs.
The decision in six questions
- Is the system on the Services Australia register for Medicare claiming, and conformant for My Health Record, e-prescribing and secure messaging (medical), or health-fund claiming (allied, dental, optometry)?
- Does it integrate with the imaging, pathology or dispensing systems the practice will actually buy?
- Cloud or server, and who is responsible when each fails?
- What does it cost at your practitioner count in year one and year three, including setup and migration?
- Can your practice manager and your locums already use it? Familiarity is worth more than a feature.
- What does it need from the fitout: data points, a comms room, dedicated power, a second connection?
Answer six before the services design is issued. The systems change; the cabling stays in the ceiling for the life of the lease.
Resources
- Services Australia: Medicare online claiming and the conformant software list.
- Australian Digital Health Agency: My Health Record, e-prescribing and secure messaging conformance.
- OAIC: privacy obligations for health service providers.
- RACGP Standards: the information management criteria a general practice is accredited against.
- Medical centre design: where the comms room and the data points go on the plan.
- Fitout cost estimator: the IT, phones and software line in the full budget.
Sources and further reading
Vendor names are the systems we see in the practices we fit out; prices are the ranges vendors and practice-setup guides publish and change without notice. Check conformance on the Services Australia and Digital Health Agency lists rather than a vendor's brochure.
Medicare Online Claiming and the software vendor register for claiming conformance.
My Health Record, electronic prescribing and secure messaging conformance for clinical software.
The Privacy Act, the Australian Privacy Principles and the Notifiable Data Breaches scheme as they apply to health records.
Standards for general practices, 5th edition. The physical-practice requirements behind general practice accreditation.
Questions
What practice management software do Australian GPs use?
Best Practice, MedicalDirector (Clinical and Pracsoft on a server, Helix in the cloud) and Zedmed carry most general practice. Genie and Clinic to Cloud are the usual specialist pair. All are registered for Medicare online claiming.
Is cloud practice software better than a server?
Neither is better by default. Cloud removes the server, its maintenance and its replacement, and adds a subscription and a dependence on the internet connection. A server keeps working without the internet and stops when the server does. Design the fitout for whichever failure you chose.
Does a cloud practice still need cabling?
Yes. Two data points per consulting room, one per reception workstation, two in treatment. Wi-Fi is a convenience, not the backbone for a clinical record, and hosted phones run over the same network.
What does practice management software cost?
Medical systems commonly run $150 to $500 a month per user in the cloud, with $3,000 to $8,000 of setup and migration; allied health systems $45 to $150 a month per practitioner, or free at the core with charges for SMS and claiming. A server is $3,000 to $15,000 up front plus IT support.
When should I choose the software?
Before the services design is issued, because the choice decides whether the fitout needs a server room, how many data points each room gets and which circuits are dedicated. Changing it after the ceiling closes is the expensive version.
Send us the floor plan
A site assessment tells you what the tenancy can take and what it will cost to get there, ideally before you have signed for it.