Life is Good With EHRs : Case History

 Our goal of being on the forefront of technology encompasses all aspects of our practice, including information technology. MOS shifted from paper records to an electronic health records (EHR) solution last year to eliminate out-of-control transcription costs, improve the doctors’ quality of life and enhance patient care. With overwhelming stacks of patient charts to pore over after clinic hours and at home every night, our physicians were overworked and had no time for a personal life.

The Selection Process

 We were committed to moving the clinic forward on the latest information technology platform. We started thinking about shifting to an EHR two years ago, but did not get serious about it until a year ago. When we started evaluating product solutions, one of the physicians at MOS strongly advocated an EHR created specifically for orthopaedics by a physician in Pennsylvania.

 As the vendor review process was drawing to a close, a local sales representative approached us about iMedica’ s Patient Relationship Manager, a practice management and EHR solution. He introduced us to a local physician practice that was using it and agreed to show us its plusses and minuses. After viewing a demonstration, we selected this particular EHR based on its modular technology, ease of use, ability to customize and portable tablet technology. The advantage of a local support organization with an excellent reputation sealed the deal for us. The physician, who originally wanted the orthopaedics-specific EHR has become a strong advocate for the selected solution.

 In addition, one of our main criteria for evaluating EHR vendors was their ability to work in a hosted environment and interface with other parties. Many vendors were reluctant to do that. The EHR manufacturer we selected has developed a positive relationship with our host, 7 Medical Systems, so that anything that needs to be done is accomplished in a timely manner. The software was designed so that we can maintain the system.

Staff Appeal

 The EHR has many features that appeal to our physicians; for example, the iMedica proprietary replication functionality is truly unique and is another reason we selected this EHR. If a network connection is lost, physicians can continue to work in real time on the tablet, initiating and completing charts, regardless of whether the network connection is available. When the network syncs back up, their input is replicated. This feature allows our physicians the freedom to work when and where they want, even on an airplane. I have been known to work on charts en route to France or Beaver Creek, Colo. at 30,000 feet with the reassurance that all of my inputted information will be saved on the system.

 The EHR also provides a competitive advantage because it is perceived as a high-tech benefit, enabling us to attract top talent to help provide the highest quality patient care.

 The EHR can be customized according to doctors’ individual practice patterns and preferences. The physicians like using the dynamic charting options instead of templates. The EHR also is designed for all levels of computer literacy, from basic to advanced users. The irony is that the least computer-savvy doctors are using most of the EHR’ s features. The physicians who took the time to save time by learning how to navigate the application have been the most successful. Although Laurie Koch, M.D., a hand surgeon at MOS, was not a willing convert, she is now the first to say that she will never go back to paper records.

 Another benefit is the tablet’ s portability. Physicians do not sit in the exam room with their backs to the patient while they document the encounter. They can sit facing the patient as they input information on the tablet. Forty percent of the physicians chart medical information into their patients’ records in real time during the exam, reducing the after-hours workload.

 One of the features we wanted was a tab to document radiology reads. When MOS raised the issue with the manufacturer, they made a commitment to add the feature; the functionality is now standard product.

Implementation

 MOS and the vendor realized that local support during implementation was critical for success at all four locations. Without it, the project would have imploded. When the vendor reviewed the situation and decided to implement support services from InforMED Group, a local value-added reseller, all systems were go.

 We used a two-phase implementation, during which half of the physicians went live in January 2006; the other half went live in February 2006. This seemed logical because three orthopedists could work while the other three trained.

 Before implementation, some physicians were seeing up to 30 patients per afternoon. Within two weeks of implementation, they were back to their normal schedules and seeing 30 patients in a half day. By quickly rebounding to pre-implementation productivity levels, physicians were able to achieve their quarterly productivity bonuses in the first quarter that we were live.

Return on Investment

 The EHR has provided measurable financial benefits for MOS. Clearly demonstrating how it has led to improved healthcare quality and staff productivity validates our investment, and guides continual improvement in our processes.

 MOS was able to enlarge its medical assistant staff, while reducing the medical secretary staff by two full-time employees and redirecting one full-time medical records employee to a new role. Previously, there was one secretary per physician; now there is one secretary for every two physicians. After implementing the EHR, MOS added a new physician in August 2006 without increasing staff and we recently hired an operations manager to free us up so we can work on outcomes.

 The EHR has enabled the practice to cut costs dramatically. We completely eliminated transcription costs as of April 30, 2007. Previously, costs were $130,000 annually. The clinic also was able to reduce courier costs by 50 percent, from $12,000 annually to $6,000 annually.

 Immediate billing has made a very positive impact on our cash flow. A major benefit of the EHR is that we are not losing charges due to untimely filing. We instituted a notes policy on May 1 and everyone has been able to stay current with the chart notes, with expected savings of 10 to 15 percent in the first year. Everything is processed within one week, with 70 percent of charges processed within 24 hours.

 Another advantage is that we no longer need to fax charts between locations. In addition, printing costs already have been reduced 50 percent because physicians are using the EHR’ s document generator to process their forms. As we fine-tune this function, we expect printing costs to continue to drop.

Improved Patient Care

 MOS has been setting new standards for highly personalized patient service. Quality of patient care has improved because staff members and physicians are not stepping over each other to hunt for paper charts. Doctors’ orders and prescriptions are now done electronically rather than handwritten, reducing the risk of transcription errors and other mistakes. Access to patient charts, notes, and test results and X-rays after hours is very beneficial when treating pre- or post-op patients. A drug prescription can be verified at 1 a.m., if necessary.

 Our patients are very excited about the EHR because it underscores MOS’ s commitment to providing leading-edge care enhanced by technology. Their appointments are now on time, so if a patient is scheduled at 11 a.m., the doctor sees him at 11 a.m. The perception of the patient is that MOS is providing more thorough, current and better care. No patients have complained that we are providing automated, rather than personal service. In fact, MOS received Fairview Physician Associates’ top award for most improvement overall when the biannual patient satisfaction survey asked how the patient would rate the care received at this clinic.

 In the recent Mpls. St. Paul Magazine’s ” Top Doctors” issue, several MOS physicians were voted ” Top Doc” by their peers in the Minneapolis medical community for providing the type of care that they would select for their own families.

 The EHR also provides a competitive advantage because it is perceived as a high-tech benefit, enabling us to attract top talent to help provide the highest quality patient care.

Life is Good

 My partner Edward W. Kelly, M.D., once said that if after implementing an EHR, the practice did not save any money, costs remained the same, but his quality of life improved, then the implementation could be called a success.

With the EHR, physicians can go home, eat dinner, put the kids to bed and then tie up any loose ends on their computer in 20 minutes, as opposed to a few hours using the paper chart method. For Koch, the EHR has been a time saving boon. Previously, she spent one full weekday dictating and she also worked on weekends. After hours, she worked an additional three hours. With the EHR, she works only 45 minutes on her follow-up each day, thereby gaining 2 hours and 15 minutes of personal time daily.

 The advantages of an EHR provide compelling reasons for a medical practice to consider the switch from paper charts. MOS’ s positive experience in decreasing practice expenses, while simultaneously improving the quality of care for patients and quality of life for physicians, attests to why EHRs are worth the time and investment.

September 2007