Health Management Technology

As populations grow, medical offices across the country struggle with an increasing amount of paper-based patient charts and records, and many are seeking alternatives. Paperless office solutions, such as electronic medical records (EMRs) have made strong in-roads by streamlining operations, and mobile technologies, such as laptops, and especially Tablet PCs, are changing the way many clinicians make rounds, prescribe medications and order procedures.

The Bellevue Family Medicine Association (BFMA) in Bellevue, Wash. has maintained a commitment to advancing the quality and content of healthcare for more than 29 years. Meanwhile, it remained open to the adoption of new innovations in both diagnostics and treatment techniques for its patients in an effort to provide the most comprehensive services possible.

As a successful healthcare provider with more than 100 patients needing care daily and more than 10,000 active patients charts, it became apparent to the physicians that BFMA’s workload had exceeded a reasonably sized workforce. The full-time staff was drowning in paperwork, caused by the archaic task of manually entering all data, from appointments to billing. A large portion of the staff spent much of each 8-hour workday absorbed by data processing. The office was inefficient at best.

The Right Combination
In 1995, BFMA explored modernizing and streamlining the office. After considering the available options, the organization installed an online electronic Practice Management (PM) system. However, after several years of use, the physicians felt the PM system had failed to accomplish their goals. The front office saw gains in efficiency, but the back office remained overburdened with paperwork and dictation tasks.

In 2002, the physicians set out to find the right combination of mobile devices and Web-based software to help automate all tasks, including the back office, which they believed would lead to increased efficiency.

By June 2004, BFMA had supplemented their existing PM system with Chart Connect, a Web-based EMR; five Toshiba Portégé M205 Tablet PCs; and, MD-Connect, an online patient portal system. After two years of research and implementation, BFMA had finally become a completely electronic clinic.

Connecting the Dots
Chart Connect demonstrated itself to be cost effective and easily purchased, and the installation was simple and straightforward. MD-Connect showed great promise as a medical record-keeping system in terms of improving the patient experience. In 2002, BFMA beta-tested MD-Connect to send lab results and physicians comments to 5,000 (roughly half) of its clinic patients. Those BFMA patients could review their information from virtually any Internet-enabled location.

However, it was the Tablet PCs that bridged the software programs and brought comprehensive efficiency to BFMA. Weighing as little as the average paper patient chart, a Tablet PC can store thousands of electronic patient charts and medical records. Based on the price, and the desire for a complete electronic office system, the Tablet PCs fit seamlessly into BFMA’s goals. The staff could work with traditional keyboards, or they could rotate and fold down the screens and use the Tablet PCs as electronic notepads. This flexibility enabled physicians and support staff to choose any method of data entry that suited their workflows, skills and preferences, such as voice/handwriting recognition, and stylus or keyboard data entry.

BFMA employed an IT support company to oversee the installation of the new equipment and software. Patient volume was reduced by 10 percent for approximately one month to ensure a smooth rollout. The staff trained in shifts so that each employee would be adequately prepared to use the new system, as well as maintain the high quality of service their patients had grown to expect.

Though BFMA’s office information flow increased, it became clear that there was a final clog in the system involving the medical assistants. The quick and appropriate solution was to provide them with Tablet PCs as well, which enabled them to import their notes directly into the digital system, similarly to their doctor counterparts.

Opening the Flow
The inclusion of Tablet PCs, the EMR system, the PM system and the patient portal, dramatically widened the flow of information at BFMA. Transcription costs were eradicated, as staff members employed voice and handwriting recognition, and stylus or keyboard data entry on their Tablet PCs. The Web portal has enabled patients to make appointments online, and ask their physicians follow-up questions concerning treatments and prescribed medications.

The physicians can answer incoming patient questions instantly without pulling a physical chart. They also can order prescription refills, and securely report laboratory and radiology results to patients. This has dramatically reduced turnaround time for office communications, largely through the elimination of lost or misplaced handwritten messages.

All Protected Health Information (PHI) is transmitted between the EMR and MD-Connect via encrypted messages, the access to which is controlled by three levels of logins. Once on the MD-Connect servers, the PHI never leaves. Patients and physicians involved in a case are alerted via e-mail as to the presence of new messages, or lab results, and must log onto the secure site in order to view the information.

The physicians no longer feel shackled to the office, because they can communicate digitally. In addition, BFMA’s bottom line has been substantially improved.

Bottom-line ROI
Integrating the Tablet PCs with the new Web-based EMR and patient portal dramatically reduced the amount of paper BFMA required to conduct business. The initial cost was less than $50,000, which included purchasing five Tablet PCs, all software licenses, training, and the installation of the EMR and patient Web portal.

As a result of this, dictation time is virtually nonexistent, chart pulls and filings have been reduced by 90 percent, notifications of patient laboratory and imaging results have been reduced by 80 percent, phone messages have been cut by 50 percent, and the time necessary to process appointment requests is down by 80 percent. Additionally, staff was reduced from 27 FTEs to 24. Collectively, this translated into a $90,000 reduction to BFMA’s overhead during the first nine months. BFMA expects to save approximately $1.2 million during the first 10 years of deployment of the electronic clinic.

BFMA’s patients quickly embraced the Web resources at their disposal. Within the first year, more than 3,000 patients registered to use the patient portal, and today, more than 5,000 patients communicate electronically with their providers.

For more information on Toshiba Tablet PCs,
www.rsleads.com/702ht-204