How to choose a charting platform for your lactation practice (Updated August 2019)

Milk Notes, ChARM, Practice better, IntakeQ, Mobile Lactation Consultant, electronic charting, HIPAA

Setting up the infrastructure for your lactation consultant private practice involved a lot of decisions, and managing your client files and communications can feel daunting. There are so many options, from paper forms to 100% paperless solutions to somewhere in between.

But just like with raising a baby, there is no one right way to do things. You’ve got to explore your options and figure out what fits your practice size, your practice setting, your budget, and your long term goals.

In this blog post, I’m going to explore the top EHR platforms used by lactation consultants throughout multiple key categories so that you can make the best decision for your private practice.

All have been exhaustively tested for use in a lactation setting and are recommended for use by IBCLCs. You may notice that some platforms mentioned in Paperless Private Practice for the IBCLC have been omitted, and that’s for a good reason—they’re no longer recommended. You’ll see IntakeQ has been added as an option. MilkNotes keeps adding new features and this post will be updated as those roll out.

Privacy

HIPAA

All of these platforms promise HIPAA compliance. IntakeQ, ChARM, and G-Suite will give you a Business Associates Agreement. The other platforms promise HIPAA compliance but do not give an explicit BAA.

PIPEDA

Jane and Practice Better are Canadian companies and promise full PIPEDA compliance. In many instances, HIPAA compliance will make a platform PIPEDA compliant as well, but be aware that if you are required to store your data on Canadian servers then you would do best to stick with a Canadian platform.

GDPR

Jane, IntakeQ, Practice Better, and G-Suite offer specific tools and guidance for GDPR compliance. In many cases, HIPAA compliance will meet GDPR standards but there may be some issues with long term record retention policies because GDPR allows citizens the right to have their digital files deleted completely.

Customizable Templates vs. Lactation Specific

The issue of customization and personalization may be the single most important deciding factor, at least going by the conversations I’ve had with the lactation consultants in the Facebook group and privately. You may have a feeling already about whether you want a platform that comes with lactation-specific templates, or if you are going to want to be able to create your own templates.

If you want pre-made intake forms and charting templates specific to lactation work, then MilkNotes and Mobile Lactation Consultant are your options. However, this doesn’t mean you’re 100% locked into their formats. You can always supplement with other platforms for your specific needs. For example, both platforms have free text areas where you could use PhraseExpress or another quick text application to build your care plans. You can also upload PDFs into both platforms, meaning you could use something like G-Suite or Acuity to gather your intake in advance.

MilkNotes does allow you to add your own custom templates to the preinstalled lactation-specific templates, including resource PDFs you have created or purchased. Please keep in mind that some paper handouts prohibit electronic transmission; always check copyright and permissions before uploading any file you’ve purchased from a third party.

All the rest allow you to create your own charting templates, or import templates that others have made, like the ones I’ve made to go with my training modules for ChARM, Jane, Practice Fusion, G-Suite, Practice Better, and IntakeQ. Simple Practice doesn’t allow for users to share templates to their library, so you’ll be starting from scratch to build your own templates. Kareo allows you to create your own templates; I’m currently researching whether or not I can develop shareable templates.

G-Suite is a completely DIY solution. It’s low cost, but requires you to do all the account maintenance and management.

Client Intake Experience

With almost all of these platforms, your clients will log in to a secure client portal to complete intake forms and sign consents. IntakeQ has a cool feature where you can ask a client to modify their form after they’ve filled it out.

MilkNotes does not yet support a complete intake experience but on the Pro plan you can collect demographic and insurance information in advance, and have consents signed.

With Mobile Lactation Consultant, your client will have to download the MLC app in order to complete your forms. There is a web-based portal but it requires a plugin that some browsers won’t have. There are enough barriers for the client that you can’t expect to have 100% compliance with completing your forms in advance. A potential glitch is that your client might complete the intake in Demo mode and then you won’t get it, and if they close the app they’ll lose everything they’ve done. Your clients will need to follow the instructions exactly as written.

Offline Access

Mobile Lactation Consultant offers full off-line charting capabilities. Because you access MLC through an app (iPad only), you can do all your charting offline and then MLC will sync once you’re back online with no interruption in service. In reality, sync may not happen automatically. You should know that until you sync, any data that you’ve entered off-line only exists on your device and if anything happens to it, MLC cannot recover it for you. Once it’s synced to MLC’s servers, it is theoretically safe.

ChARM and Simple Practice also have apps for charting offline, but they’re not as user-friendly as MLC, and ChARM’s can be downright glitchy. MilkNotes, Jane, IntakeQ, Kareo, Practice Better, and Practice Fusion require you to be online while charting.

Integrated Online Scheduling

Jane’s online scheduler is the most beautiful and the most user-friendly of all the platforms surveyed here. It will look great when embedded in your website, and it’s truly mobile responsive. ChARM has made great advances recently with the appearance of its online scheduler. However, neither one comes close to offering the power and flexibility that something like Acuity provides. Simple Practice has a very pretty and client-friendly online scheduler.

IntakeQ’s embeddable scheduler offers many of the same features that Acuity does. Appointments can be grouped into categories, you can add padding to your appointments, you can offer coupons, and you can create packages. All of these features are included in the $59.90/month plan.

MilkNotes, Practice Better and Kareo have integrated scheduling that lacks the bells and whistles of Acuity and IntakeQ, but will allow you to enjoy some of the benefits of online scheduling.

You won’t get integrated scheduling with PracticeFusion, G-Suite or Mobile Lactation Consultant; however, Acuity can handle your online scheduling needs for any of these platforms.

Secure Messaging

If you choose G-Suite or Practice Fusion, you’ll need a separate secure messaging solution like Spruce, OhMD, or Signal. Most of the others integrate secure messaging seamlessly into the platform itself. The exception is Mobile Lactation Consultant, which has secure messaging but it’s extremely difficult for both you and the client to use effectively.

Clickable Links

When you create a care plan in G-Suite, ChARM, Mobile Lactation Consultant, MilkNotes, Practice Better, Simple Practice or IntakeQ, you’ll be able to share a version with the client that has clickable URLs. In the other platforms, clients will have to copy and paste a link before they can view it.

Insurance Billing and Claim Tracking

Most the platforms listed here allow you to add diagnosis codes and procedure codes to your consults and to track payments you receive from insurance companies.

ChARM, Kareo, and IntakeQ offer the most robust claims management systems and are the best choices for practices that do a lot of in-network billing. Kareo also has its own clearinghouse and that integration would be the main reason to choose Kareo.

IntakeQ and ChARM integrate with Office Ally and also allow you to upload and map your own EOBs. Theoretically, both will also allow you to bill clients for cost-sharing, but the ChARM payment integration is a real nightmare and has a monthly fee. IntakeQ will connect with either SquareUp or Stripe so you can process credit cards through the portal.

PracticeBetter will create a CMS-1500 form but won’t track submissions and payments from the insurance company. However, you can use them to bill clients for cost-sharing through Stripe or SquareUp directly from Practice Better.

MilkNotes generates superbills with demographic and insurance information prepopulated if supplied by the parent. Mobile Lactation Consultant generates superbills and CMS-1500 forms with some prepopulation. It also will let you track claim submissions and payments but the workflow is really cumbersome. Neither of these platforms will allow you to collect cost-sharing.

With G-Suite, you’ll need to manage your insurance claims and payments outside of the platform, though you will be able to notate diagnosis and procedure codes on the visit.

Integrated Payment Processing

Jane integrates with Payfirma for payment processing, meaning you’ll be able to take a client’s credit card and keep it on file at the time of booking, and charge them at the time of the visit or later if cost-sharing is applied to their insurance claim. Fees are reasonable and the application process is simple.

ChARM integrates with Bluefin for payment processing, but it’s quite difficult to use and frankly not worth the hassle.

Practice Better and IntakeQ integrate with both Stripe and Square. Kareo integrates with Stripe. These platforms are easy to set up and the fees are low.

Growth Charts

ChARM and PracticeFusion provide growth charts using the WHO standards for babies. ChARM’s is limited but easiest to see, while Practice Fusion’s is quite hard to see for infants when weights are plotted close together. Kareo has a growth chart. MLC and MilkNotes will track weights in a list form, but will not plot them on a visual graph. Milk Notes integrates the NEWT tool which works for the first 30 days of life.

The others don’t have a way to track or visualize weights. An external app like Growth will be necessary for creating a visual growth chart.

Telehealth

ChARM, MilkNotes, Practice Better, Jane and Simple Practice offer integrations for Telehealth. The others do not.

Pricing

If price is an issue and you have a low volume practice, then check out my blog post on running a paperless platform for under $25/month.

When you sign up for encrypted email with G-Suite, you get Docs, Sheets, and Forms, which are all you need to build your own DIY charting platform like I’ve described in my G-Suite training module.

ChARM’s pricing structure means it’s free (if you don’t sign up for any add ons) as long as you have fewer than 50 encounters a month. That’s 50 consults if you only keep charts for the parent, 25 consults if you keep separate charts for parent and baby. This is a great deal, and even when you grow larger you’ll only pay $0.50 an encounter, making it an affordable option.

Mobile Lactation Consultant is only $19 a month if you have 25 or fewer new clients each month, and only $39 for more.

MilkNotes is  $29.99/month for a plan that does quite a lot, and upgrade to $49.99/month to add telehealth, online scheduling, integrated faxing, and secure messaging. Discounts for groups and for annual pricing are also available. MilkNotes is the only charting platform to offer an integrated pump tracker, so if pump rentals are a significant part of your private practice, you’ll definitely want to do a trial to see if MilkNotes would meet your needs.

IntakeQ’s plans start at $29.90/month for a low-volume practice, and increase as you get busier and add more features.

You’ll make a bit of a price jump to get to SimplePractice, because you’ll need the $49/month plan if you want to customize your own charting templates.

Practice Better is $49CAD/month for 100 active clients, and $79CAD/month for full features and unlimited active clients.

Jane will run you $74/month and you’re paying for aesthetics, and PracticeFusion is $99/month with a one-year commitment. Kareo is $100/provider/month but can serve as a charting platform and a scheduling platform.

Will you like it?

I wish I could answer that question for you! I hope you’ve seen in this blog post that you’ve got a lot to consider because the decision is so personal. For a granular, side-by-side comparison of all of these platforms with even more features assessed, check out my comparison chart.

And I’d love to help you choose your platform. Learn more about my phone and email consults here.


Annie Frisbie, MA, IBCLC is the creator of the  IBCLC Private Practice Essential Toolkit , a collection of books, resources, legal forms, training manuals, and workbooks aimed at helping private practice lactation consultants build a private practice that’s ethical, profitable, sustainable, and enjoyable.

ABOUT THE AUTHOR

Annie Frisbie, MA, IBCLC is the creator of the Lactation Consultant Private Practice Toolkit, a collection of books, resources, legal forms, training manuals, and workbooks designed to help private practice lactation consultants build a private practice that’s ethical, profitable, sustainable, and enjoyable.

In 2018 she was honored with the US Lactation Consultant Association's President's Award. Through her popular blog, online store, podcast, and one-on-one coaching, Annie has helped thousands of lactation consultants grow their businesses with simple systems that make their lives feel easier and more joyful!


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