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From the October 2003 Issue Converting Interim HIPAA Fixes Into Long-Term Strategies |
Taking It to the Next Level Georgia specialty practice provides greater care by improving efficiency with EMR system. Specialty practices may stand to gain from using an electronic medical record (EMR) in a way that exceeds the benefits typically experienced by a general practice. Timely, accurate documentation is critical, of course, and the level of detail that specialists must denote and report to referring physicians and patients presents additional opportunities to benefit. PROBLEM Georgia Pediatric Pulmonology Associates (GPPA) is one of the largest single-specialty practices in the country that is solely dedicated to children suffering from lung disease. Its eight physicians, three physician assistants and three pediatric nurse practitioners (PNPs) currently serve 100 to 120 patients per day in the Atlanta area. As a specialty practice, we are extremely conscientious and detailed in documentation, paperwork and patient instructions. The use of paper charts led to numerous problems including misplaced files, paperwork overload and the inability for multiple physicians to view and update patient charts simultaneously. We knew it would be difficult to grow the practice if we could not first streamline our administrative processes. The greatest problem we faced was documentation overload. After each patient visit, we automatically send a detailed referral letter to each patient’s primary care physician. We spent an excessive amount of time, effort and capital investment dictating, transcribing and mailing out these letters, many of which have similar content. The paperwork involved was debilitating. Because we provide comprehensive patient instructions after an office visit, our documentation for patients was equally detailed and very time-consuming. When we realized that we were spending $65,000 per year on referral letters and transcription costs alone, we began searching in January 2000 for an EMR system to streamline office workflow, improve patient care and save money. SOLUTION As a group, we discussed going electronic for six to nine months prior to even looking at options. Our initial evaluation consisted of on-site demos from various EMR companies. Our practice administrator and the business office manager conducted the first evaluations. They narrowed the decision to two companies—one of which was A4 Health Systems, based in Cary, N.C.—and then those companies each made a presentation to our physicians. After the physicians presentation, we met again with A4 representatives for a site visit, and in January 2001 we chose the company’s HealthMatics EMR program for its customizable nature, powerful software and the company’s good reputation for customer support. GPPA needed a system that would provide great output and was practical and useful for all specialties. We also wanted a program that was user-friendly and easy for our staff to adopt. With doctors ranging in age from 32 to 54, we believed this EMR system was straightforward enough for everyone to use with ease after basic training. The system was fully compatible with all of our hardware, software and existing infrastructure, including our Misys practice management system. It allowed us to use handheld Fujitsu P1035 devices—ideal for a practice serving small children—while moving from room to room without constantly logging on and off of the system. IMPLEMENTATION In May 2001, we began our training on the EMR system. The overall training lasted about 88 hours, with various employees taking part in groups as necessary. The extensive training lasted two to three days at the Cary facility. This training provided us with enough information to utilize the system, although we continued to learn new features and procedures for months after going live as we became more familiar with system. Since we work with children suffering from pulmonary disease and winter is our busiest season, we chose to go live in July, our least busy time of the year. We chose to do a full implementation, rather than an incremental one, and everyone was fully using the system on the first day. We had no software integration problems, which made for a smoother transition than we expected. RESULTS We experienced a full ROI only 14 months after implementing the EMR system. Transcription and off-site storage costs were eliminated, saving us up to $70,000. The space previously dedicated to medical record storage was transformed into a nurses station. Before implementation, our practice utilized two full-time employees (FTEs) to manage our medical records. With the EMR system, we only need to dedicate one FTE to scan outside documents from hospital work, reducing employee compensation costs. This allowed us to promote an employee to work at the front desk, where we had already planned to hire additional staff. Because of the EMR system’s customizable nature, we are still updating the application regularly to make our daily processes easier. For example, the use of custom drop-down menus and pre-authored text greatly reduced the number of keystrokes we have to make while reporting a patient assessment or writing a prescription. All of the commonly used terms, phrases and even the dosages that we previously had to type in for each record or prescription are now easily entered with one drop-down menu selection. In the past, our physicians worked on dictation for several hours after the last patient left the office. After implementing the EMR, we could leave right after the last patient, eliminating several hours of work at the end of the day. The implementation of an EMR has allowed us to bring our patient care to a higher level. With more efficient office and administrative processes, we can focus our efforts on providing superior care to our patients. For example, the EMR system allows doctors to securely logon to the system remotely to access patient records as needed. Each doctor’s home was secured with a WatchGuard Technologies firewall security system. This enabled physicians to use either their home PCs or to take their office laptops home to connect. Now, our overnight on-call doctor can respond more efficiently to patient inquiries and potential emergency situations in the middle of the night by accessing the call-in patient’s record from home. On-call physicians can see a child’s medical history, allergies and current medications—all critical and documented information that we can’t always rely on parents to remember accurately. Our patients have noticed that we are providing a higher level of service. Patients now receive a legible, detailed printout of customized instructions after each visit. Their prescriptions are always timely and accurate with our electronic prescription system. In fact, our office procedures are so efficient that visits require less time, paperwork, waiting and frustration. For example, the system allows the examining physician to order a prescription from the exam room on his or her handheld computer. A medical assistant pulls the prescription off a central printer, finds a sample and brings the paperwork and the sample to the patient before the patient leaves the examining room. Patients tell us they are amazed by this level of service and efficiency, and they take comfort in knowing that we have invested in a system that allows us to provide these services. They have made the connection between us wanting to be administratively efficient and also wanting to stay at the cutting edge of medical research and development. Finally, the implementation of an EMR system helped facilitate expansion of our practice. The system has helped us to grow from six physicians and two PNPs to our full capacity without adding back-end office support. While we were seeing approximately 80 patients per day in 2000, we are now seeing 25 percent to 50 percent more patients per day and serving approximately 20,000 patients annually. For more information about
HealthMatics EMR from A4 Health Systems SOURCE Burt Lesnick, M.D. PRODUCT/COMPANY
© 2003 Nelson Publishing, Inc |
HealthMatics EMR