How to make MilkNotes work for your lactation practice

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I'm a big fan of my colleagues who are out there taking risks and developing products for our community. Hardly any of us would be here today without the paper charting forms developed by Diana West or Pat Lindsey's superbill, which trained so many of us in understanding how insurance reimbursement works. These products are still invaluable and irreplaceable in a paper-based workflow and I recommend you check them out if you're not ready to make the leap to a paperless charting system.

Since paperless is the name of my game, I want to make sure that you know about MilkNotes, developed by IBCLC Liz Flight to be a cloud-based charting system designed specifically for lactation work.

Here's what I love about MilkNotes

  • Liz is in the trenches with us, and the workflow of the app "feels" like private practice to me

  • The reports generated by MilkNotes are simple and beautiful, and will make great marketing tools for those pediatricians you're communicating with. Better reports may mean more referrals.

  • The interface functionally separates the mother and the baby's chart, while visually keeping them on the same page using tabs. I'm a huge fan of this feature because the less jumping around I have to, the better!

  • The feeding record toggles between lbs/oz and grams. Enter one way, and the app will do the conversion for you.

  • The physical assessments use dropdown menus (easy) and also let you add your own options.

  • The narrative fields are well placed to encourage you to add more as needed.

Services that pair well with Milk Notes

Online Scheduling

If you want online scheduling, you'll need an external service for that. I'm a big fan of Acuity Scheduling, especially if you're juggling a lot of offerings. With Acuity, you can have multiple offerings, such as home visits, office visits, phone support, support groups or clinics, and even services like an email support subscription, all of which can be paid online with Acuity.

The price on Acuity is prohibitive for some, so for a lower-cost option check out SquareUp. You'll need to do some fine tuning to make sure that your account is HIPAA-secure; primarily, you need to set your account as Medical and make sure that you disable any sharing settings (so SquareUp can't send your clients emails asking for feedback or share their contact info with their other vendors).

I haven't tried Yellow City myself, but it's HIPAA-compliant and affordable.

Client Communications

MilkNotes does not yet have a secure messaging function (though I'm sure she's planning to add it), so you'll need a secure way for clients to communicate with you. The care plan feature uses built-in dropdown templates to create a document you can print on paper or to PDF for emailing to your client. You will not yet be able to add clickable URL links to this care plan. I'm a huge fan of clickable links for my clients, as

Because you'll need secure email and document storage that conforms to your country's privacy laws, I do recommend having a paid account with G-Suite or Office 365. Both of those services will provide a Business Associate Agreement making them suitable for storing and transmitting PHI. You can then follow the workflow in this post in order to create a shareable care plan for your clients. Basically, you'll be doing your charting in Milk Notes and then using an external document service to create and share the care plan.

If you add Paubox encryption to your email, it seems that will create a secure environment for client messaging. I'm not going to lie--Paubox is pricey. But look at it this way--you're going to have to pay one way or another. When services are free, you are still paying, by giving up your private information. It may not be money, but it's currency, and it's valuable. As a healthcare provider, if you use a free service with your clients, essentially you are paying for that service with your clients' private information. That is not yours to spend. So in order to prevent paying with your clients' information, you're going to have to pay with money. That's the ethical way, and in many countries it's the law.

I use Spruce myself for secure messaging because it also gives me a business phone line, and if you mention me we will both get a free month. I also like this workaround for using G-Suite Docs as a secure messaging environment.

Billing and Invoicing

MilkNotes won't yet track financial information for you, such as payments received or insurance claims generated, and it won't create a superbill for you. You're going to need your own system for that.

SquareUp works great for receiving client payments and tracking your financials. You can swipe credit cards at the time of the visit or integrate your SquareUp account with Acuity Scheduling for online payment. 

If you're accepting insurance, you'll want to maintain your own spreadsheet of claims generated and their submission and payment status, because you won't be able to do this in MilkNotes.

For the superbill, you can stick with paper using Diana West's form or Pat Lindsey's superbill, or edit them using an app like PDF Expert for Mac or one of these editors for Android. You could even make your own DIY superbill in G-Suite Docs, providing the date of service, diagnosis and procedure codes along with the appropriate location codes and any modifiers you're using, and your contact information, EIN, NPI, and IBLCE certification number. These free templates may be helpful and be sure to scroll down for some useful information on superbills.

Consent for Care and Payment Policies

MilkNotes comes with a built-in consent form which do mention payment policies. If your policies differ from what the forms describe, you're going to want to replace that with your own personalized consent form. You can modify what Liz has created, or customize my consent forms and payment policies and provide them to the client on paper or in advance. I know I keep mentioning Acuity, but I do love how it makes it so easy to get consent for care in advance and acknowledgement of receipt of HIPAA policies in advance of the visit. If you do that, you won't need to use MilkNotes for consent forms at all. This post explains how to create custom intake forms in Acuity.

Is MilkNotes right for you?

I absolutely think it's the right platform for some of you. If you have low client volume and don't mind doing a little extra work, the price is going to be right for what you're getting. From my conversations with Liz, I know that she's very invested in making this platform grow to suit the needs of her subscribers, so I imagine there will be more features coming in the future that will eliminate the need for these extra services.

And a big thank you for Liz for taking a risk and making something just for us. Innovation in our field is always welcome!

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About the Author

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.