It wasn’t too long ago when Kavita Mariwalla, M.D., a practicing dermatologist, had a sour view on electronic medical records (EMRs). After all, throughout her training, Mariwalla experienced several systems, and none came even close to doing the job seamlessly. She says that the notes the EMR generated for consultations often made no sense and contained far too many typos. What’s more, they would say things that weren’t even relevant to the situation at hand. “I told myself that if I ever went out on my own, I would not get any of these systems. Or, if anything, I would get something that combines the best qualities of all of them,” Mariwalla attests.
Lo and behold, a few years later, Mariwalla did move out on her own, starting with just one nurse, a cart, and three iPads. She looked into a company called Modernizing Medicine, based in Boca Raton, Fla., which was just starting out at the time. Mariwalla knew the co- founder of the company, Michael Sherling, M.D., who was also a dermatologist. “I remembered that he was a smart guy, so I looked into his product,” Mariwalla recalls. Indeed, Sherling was a smart guy, as was the other co-founder of the company, Daniel Cane, who had an Ivy League education, having also founded Blackboard Inc., a technology solutions company dedicated to helping improve every aspect of the education experience. Specifically, Mariwalla looked into their company’s flagship product, its Electronic Medical Assistant, a cloud-based, specialty-specific EMR system with a massive library of built-in medical content, designed to save physicians time. The idea behind EMA is that it aims to adapt to each provider’s unique style of practice and interface with hundreds of different practice management systems. Officials of the company claim that this system is the first EMR with cognitive learning abilities and natural language processing, and has been granted access and integration with IBM Watson.
Now with her own practice, Mariwalla Dermatology in West Islip, N.Y., Mariwalla has a 14-room office that that was built in just three years. Mariwalla says she uses EMA, for which she pays a monthly user fee, to help with everything from e-prescribing to meeting meaningful use requirements (her practice just attested to Stage 2) to more efficient care in her office. Just recently, Mariwalla says she had a young patient who had a serious infection on his scalp. The patient was already taking the medication that Mariwalla was going to prescribe him, so she went into EMA to see what else users across the network were using for this issue, as well as to see what the patient has used in past. “So you can see what other options are and if it’s been used in the past. That makes you feel better,” Mariwalla says. “Also, with its embedded Watson technology [from the Armonk, N.Y.-based IBM], you can ask if the treatment is safe for a kid who is 11 years old. You can ask if there have ever been side effects for this pediatric population. That support is a game-changer, compared to leaving the room and looking into repositories or textbooks somewhere else,” she says.
The portability aspect is something that Mariwalla loves as well. No longer does she have to wait until the work week to get to her desktop and review a patient’s record, she says. “That accessibility as a physician is invaluable, and that earns you credibility,” she says. Furthermore, everything is on iPads, and being able to use technology when patients come in the door gives them this automatic feeling that the doctor must know something because she’s so state-of-the-art,” Mariwalla says. “Patients are frustrated by the medical system, dealing with co-pays, making appointments, getting prescriptions, so when you walk in and you know it’s an efficient process and that doctors are doing what they can to streamline that process, it helps,” she adds.
Mariwalla says that she also recently re-organized her office, so a space is dedicated to having an iPad station only. “When patients walk in they love that, because it’s so cutting edge. We also don’t have tons of square feet dedicated to a filing room. We’re not looking for charts all over, and everything is at a glance,” she says. To this end, on the administrative side, efficiency is improved and overhead is lowered since there isn’t a staff member who is always filing. Office space is now used to see patients and deliver patients, as it should be, Mariwalla says.
On the business end, Mariwalla adds that notes are finalized and pushed out immediately. “You can see if you’re doing an x amount of procedures, does that match up with what I am collecting? Did that get money get collected at front desk, and did that procedure happen?” she asks. For example, with the physician quality reporting system (PQRS), you can face a penalty if you don’t do it, and could miss out on a bonus. “But because of the way EMA works, I can do that at a touch of a button,” Mariwalla says. You don’t have to re-enter PQRS data, and I won’t get a deduction from Medicare,” she says.
For a dermatologist trying to open her own practice, the challenge of implementing technology and getting physician buy-in is often a very difficult one. Specific to her specialty, Mariwalla notes that dermatologists are used to often writing very specific descriptors on the body diagram, which are called the objective or the physical exam, at which point they will assess and plan. But with the EMA system, adaption is required, she says. “It’s just about a different way of workflow. Some people want to write everything down, and you can still do that, it just takes longer. You draw things in dermatology, so it’s not the same as drawing on a piece of paper, but while it seems like it takes longer, you save time in long run because you’re not searching for this one piece of paper,” she says. Mariwalla adds that she gets around that by just taking a picture. “So I think it’s equally effective. If you’re someone who is not willing to adapt well, you won’t do well with EMA, but with that thought process, you won’t do well with any technology in general.”
Technology wise, what started out as asking RadioShack for advice turned into investing money into wireless routers and air printers, Mariwalla says. And with EMA, whenever Mariwalla felt that something could work better in the system, an upgrade to fix it was made shortly thereafter. That’s what they key is, she says—making sure the system understands your workflow and the demands you need to make your system work for you. “With EMA, it’s not like you have to learn how a computer programmer would program something, but instead it’s like the programmer is taking the time to figure out how doctors work. This program was the only way I was able to go out and start a private practice,” Mariwalla attests.
