• May 2008 FEATURE ARTICLES •
PHRs/EHRs/EMRs
"Less Paper" Trumps Paperless
Sometimes, an ideal solution needs a reality check to function in today’s healthcare environment.
By Tony Thompson
For many physicians, the goal of implementing
an electronic medical record (EMR) is to rid themselves of
paper. While the paperless office is considered the ideal
healthcare environment, the reality is that it can result in
unintended consequences that can impair an office’s efficiency
instead of improving it. Why? Because, EMR technology does not
automatically enhance every business or clinical process.
Furthermore, it’s difficult for offices to achieve the
efficiencies associated with a zero-paper environment due to
trading partners such as specialists, hospitals and insurers
that not only submit, but also request, a large amount of paper
documents.
Doctor’s Walk-in Clinics, an urgent care
chain serving a three-county area of more than 2 million
residents, was faced with the challenge of providing quality
medical care with minimal waiting time at a reasonable cost for
its walk-in patients. Established in 1980, the company had grown
to seven clinics throughout the Tampa Bay region in Florida,
each offering extended hours, seven days-a-week operation, and
comprehensive services including X-rays and EKG testing and
analysis. As the influx of patients continued to increase in the
typically unpredictable manner of walk-ins, the clinics
struggled to balance the resources of its 37 full-time and
part-time physicians. To optimize resource allocation and
minimize the costs for their facilities and the patients, the
clinics decided to investigate the benefits of an EMR.
The Paper Chase
"If a patient went to a different clinic for
a follow-up visit, that clinic’s staff would have to call the
first clinic to request that the patient’s chart be faxed prior
to the visit," says Jason Dickey, vice president of marketing
and business development at Doctor’s Walk-in Clinics. "Employees
spent hours chasing and faxing paper charts from clinic to
clinic. It was inefficient at best. At worst, it was a
tremendous waste of time and resources when staff had to call
other locations to track down charts."
Today, all physicians and 240 employees at Doctor’s Walk-in Clinics use the EMR to access and manage critical patient data, enabling improved clinical decision-making and more accurate documentation of patient encounters, which has led to increased reimbursements that reflect the extensive patient care delivered.
State regulations also required that patient
records be stored for seven years, the compliance with which
presented two challenges: 1) Many of the patients were
infrequent visitors; and, 2) The clinics had limited storage
space. To comply, Doctor’s Walk-in Clinics shipped their records
to an offsite storage facility after one year. Thus, if a
patient came in a year after their initial visit, Doctor’s
Walk-in Clinics had to process a completely new chart for them
rather than retrieve their old chart, which would have also
required a removal fee. This decreased staff efficiency and
patient care.
Billing also was problematic. Every day, each
clinic would copy the charts and courier the duplicates to the
centralized billing department at the Doctor’s Walk-in Clinics’
headquarters. After receiving the charts, the company’s 11
billers labored to decipher physicians’ handwriting, extending
the already time-consuming billing and chart auditing process.
Seeing the Light
Doctor’s Walk-in Clinics began their search
for an EMR solution that was easy to use, flexible and
customizable to address the needs of diverse specialties. A
five-person EMR selection committee solicited recommendations
from similar facilities, checked references and performed onsite
visits to see various EMR solutions in action. Next, the company
arranged for four vendors to demonstrate their products in
person. This thorough evaluation took nine months, after which,
the committee collectively recommended MediNotes e from
MediNotes Corp.
In the spring of 2006, Stephen F. Dickey,
M.D., a family and emergency medicine physician who is also
president, CEO and owner of Doctor’s Walk-in Clinics, accepted
the recommendation and the implementation race was on.
Ready ... Set ... Stop
Doctor’s Walk-in Clinics elected to deploy
the new EMR in a phased manner. Initially, the company selected
a new clinic as the first site, but was forced to halt the
implementation within two days because the physicians found the
templates too difficult to operate. Returning to the drawing
board, Doctor’s Walk-in Clinics took the extra steps to
customize the templates to mirror the physicians’ workflow and
their current paper chart format, reducing the learning curve
and increasing adoption rates. They also discovered that many of
the staff still had a need for a paper-based superbill, which
was often used as a valuable "quick check" on the patient’s
location and current treatment. With these adjustments in place,
Doctor’s Walk-in Clinics restarted its phased EMR rollout.
To support the EMR launch, a Doctor’s Walk-in
Clinics’ employee became a MediNotes trainer and spent one month
training each clinic’s physicians and staff. Although the
trainees had varying computer skills, everyone became proficient
on the EMR due to its now-familiar template. Typically, we
completed the individual clinic deployments within two months,
and within 14 months, installed the EMR across the entire
enterprise.
Today, all physicians and 240 employees at
Doctor’s Walk-in Clinics use the EMR to access and manage
critical patient data, enabling improved clinical
decision-making and more accurate documentation of patient
encounters, which has led to increased reimbursements that
reflect the extensive patient care delivered.
Quantifiable Cost Savings
Prior to implementing the EMR, Doctor’s
Walk-in Clinics paid two separate fees totaling $12 to $15
whenever it had to remove and return a record to the storage
facility. The company cut that cost in half by scanning patient
records into the EMR and destroying the original chart
afterwards, rather than returning it to storage. Furthermore,
Doctor’s Walk-in Clinics saved approximately 12 hours per week
by eliminating faxes and other paper-related costs, which
equates to approximately $6,000 to $7,500 annually.
Every day, each clinic would copy the charts and courier the duplicates to the centralized billing department at the Doctor’s Walk-in Clinics’ headquarters. After receiving the charts, the company’s 11 billers labored to decipher physicians’ handwriting, extending the already time-consuming billing and chart auditing process.
"We anticipated that an EMR would improve
information sharing among our clinics and provide physicians
with access to a centralized source of patient information,"
Dickey says. "What we didn’t anticipate were the other added
benefits, such as improving our prescription methods. The
computer-generated prescriptions have helped us to communicate
better with pharmacies, and prescriptions are legible 100
percent of the time."
The EMR sharply boosted the productivity of
Doctor’s Walk-in Clinics’ 11-person billing department, saving
one day of work per week per worker. "Our billers can now easily
read, review and audit charts online instead of sorting and
struggling to read paper charts," says Dickey. "They perform
their jobs much more quickly and efficiently than before, and
can dedicate more time toward collecting rather than billing."
Doctor’s Walk-in Clinics also expect
additional savings. As of April 2012, the legal obligation to
retain medical records expires, allowing the company to dispose
of records created prior to the EMR’s rollout, eliminating a
$1,750 monthly cost for medical records storage.
"We’ve realized that intangible benefits are
often difficult to measure," says Dickey. "Now, our corporate
office can analyze the data and determine whether any of the
clinics have unusually high wait times, enabling us to identify
problems and better allocate resources by dispatching back-up
physicians to clinics that are short-handed."
Moreover, the EMR is now interfaced with
Doctor’s Walk-in Clinics’ practice management system, enabling
physicians and staff to immediately discuss treatment plans and
charges when patients call. This enhanced customer service
should result in additional referrals and repeat patient visits,
augmenting future revenue sources.
Tony Thompson is director of IT at Tampa,
Fla.-based Doctor’s Walk-in Clinics. Contact him at
tthompson@dwic.org.