How EMR Saved My Practice

After working as a salaried physician at La Familia Medical Center in Santa Fe, N.M., Ron Press, M.D., started his private family practice in April 2004 and immediately went for a paperless solution to his medical records. He decided to go with the Centricity Advance product from Chalfont St. Giles, United Kingdom-based GE Healthcare. Little did Dr. Press know at the time how integral that decision would be to the health of his practice. Press shares his experiences with integrating electronic medical records with HCI Associate Editor Jennifer Prestigiacomo.

Healthcare Informatics: How did you decide on the particular vendor you chose?

Press, M.D.: Starting out on my own, I was researching the cost of paper charts versus electronic charts, and I was looking at some of the software that was out there. Then, I contacted the Academy of Family Medicine [the Leawood, Kan.-based American Academy of Family Physicians], and spoke with the person in charge of IT there. He told me to start looking at products that interface the electronic medical record with the practice management and the billing and scheduling. So, I began looking at a few of his recommendations that were affordable for someone going into private practice, at a time when everyone is going into salaried positions and where insurance companies are making it so hard to make a living. I found this one [GE Centricity], and it fulfilled all my needs; so that’s why I started with it when I started private practice six years ago.

Since we do adult medicine; pediatrics, so we need growth charts; we do obstetrics, so we need flow sheets where you can add information to it at each OB visit; [Centricity] has all those components. It pulls everything together in a small package, so you have your whole practice on a computer. And a lot of functions can be carried out so you don’t have to hire a huge staff.

At the other place I worked [La Familia Medical Center in Santa Fe, N.M.], they still don’t have electronic medical records. They wanted to get them. They had me and some others researching, but they still don’t have it. I think people are intimidated about making the switch.

HCI: How have electronic medical records changed the way you practice?

Press: I used to dictate, but with this product, I use templates. I have a computer in the exam room, and before I didn’t have one in the exam room. I was looking at the paper chart; now I am looking at the computer screen in a location where I can still make eye contact with the patient. I can send all refills electronically while I’m in the room with the patient. Or I can send a note to a doctor for a referral while I’m in the room with the patient, just by electronic fax. It’s so much more efficient. I can show patients their lab results and x-rays on the screen. I can print out health education materials right there apropos to the patient’s visit. This is medicine joining the modern world and the computer age.

HCI: How long did it take you to adapt to using an EMR?

Press: Maybe a week for me and my staff. Because it’s created in a format where providers are already accustomed to recording information: chief complaint, history, present illness. You just click on those things, and there’s drop down menus based on the various systems. So it’s in the format that doctors are used to, so when you finish a note, you can push a button to make a template for instance for bronchitis, and you can use it for every patient that comes in with bronchitis. As time goes on, you have templates for just about everything. But you can modify the note a bit [for individual patients].

HCI: Are patients currently using the patient portal?

Press: We’re going to be doing it in the next couple of months. We have to finish our Web page first.

HCI: Why did you decide to go with an ASP rather than a server-based solution?

Press: When I first started using it, I had a server. I thought that was the way to go. I subsequently learned that was the wrong way to do it. The problem with having a server, you feel like you have to have an IT person on staff to manage the server. Maintenance of the server is a big hassle, with updates. I wouldn’t recommend anyone getting their own server. Later on [Centricity Advance] evolved into an ASP [application service provider], where everything we do is communicating with their server. That was a big breakthrough. [Before] whatever new software they developed, we would have to download it on to the server. Once we switched over to this ASP model, when we log-in in the morning, all the new updates (and they do a lot of updates to keep up with coding) would just [download] onto that machine. And by using their multiple servers, we don’t have to back anything up.

HCI: What challenges have you faced in private practice using your EMR?

Press: Starting out in private practice and billing with these insurance companies—they have so many tricks to avoid reimbursing you. GE helped with the billing too. They can see exactly what we did and run reports on how we’re billing and which insurance company is denying certain codes. So it gives you the ability to analyze your whole practice. In electronic medical records, you can analyze your quality of care in so many ways. There’s no comparison.

HCI: Can you even imagine starting your private practice using paper records?

Press: I would quit medicine. Today everything is so bad. The overhead is so high. Imagine having to hire a medical records staff, transcriptionists, billing staff. The only way you can make it is to keep your overhead down. If I didn’t use electronic records, I don’t think I could do this. I think the only thing that can help people survive in private practice today is this type of technology.

HCI: Will you be applying for the 2011 meaningful use reimbursements?

Press: Yes, we plan on doing that as soon as we learn how to do it. I think that this product already meets all the requirements.

HCI: What is the best part of transitioning from paper to paperless records?

Press: The easy access to my database from anywhere. I can do it when I’m home, when I’m scuba diving in the Yucatan. I can do refills from everywhere. I was in India in November, and I was doing refills from there. You can operate your practice from anywhere in the world; I would say that’s the most amazing thing.