A Knoxville specialty practice eliminates paper records and carves its own digital path to the EMR functionality.
For half a decade, suppliers of document management systems have categorized themselves as providers of electronic medical records (EMRs), explaining that use of their applications was a critical and incremental first step in a physician practice’s progress toward full EMR adoption. For that same half a decade, reporters and editors have winked at and wrestled with the assertion. End-users probably cared about the debate least of all, as long as they were able to continue on their path of paperless evolution.
A Knoxville specialty practice eliminates paper records and carves its own digital path to the EMR functionality.
For half a decade, suppliers of document management systems have categorized themselves as providers of electronic medical records (EMRs), explaining that use of their applications was a critical and incremental first step in a physician practice’s progress toward full EMR adoption. For that same half a decade, reporters and editors have winked at and wrestled with the assertion. End-users probably cared about the debate least of all, as long as they were able to continue on their path of paperless evolution.
Times have changed, though. Today, a practice can initiate itself into automation with what was, essentially, a document management solution, milk the daylights out of its customizable strengths to effectively provide EMR functionality, and then add an upgrade module or two for complete electronic medical record availability.
In Knoxville, Tenn., that’s what Premier Surgical Associates (PSA) and Park West Comprehensive Weight Loss Center (PWCWLC) did. With 25 providers and 75 support staff, the organization isn’t the epitome of a typically small practice, and the PSA/PWCWLC enterprise has enormous territory to cover with nine treatment locations, 500 daily patient visits and nearly 2,900 new patients each year. The organization enjoys a single corporate office and centralized billing, but beyond that, satellite offices function as autonomous units.
Office Manager Jama Stinnett, L.P.N., C.P.H.Q., is responsible for three of the nine locations that include seven physicians who constitute the Premier Surgical Associates portion of the enterprise. In 2001, as one of the three PSA locations was preparing to move into a new facility, office staff queried a vendor about the price of new shelving units to store patients’ charts. It was then they began to learn about digital document management systems, and after exploring a number of them also learned that the cost of the software for the enterprise’s 25 physicians would equal approximately the cost of new rolling shelves to house paper charts.
From Doc to Documentation
The PSA/PWCWLC enterprise went live with TouchChart software from Chicago-based Allscripts in August 2001, on exactly the day that one of the PSA locations moved to its new facility. Stinnett hired high school and college students for two months prior to scan patients’ paper records into the system. “We scanned about half of our patient records by moving day,” she says, adding that unscanned records were physically housed in a storage room. “Then, no one was allowed to retrieve a chart from the storage room without first scanning it into the system,” she adds.
“How many times do you have to save 15 minutes of staff time before you recognize you have a winner? Not many.”
– Jama StinneBy early 2002, the enterprise was rocking and rolling with TouchChart. Because all nine offices are electronically connected, every possible piece of paper was entered into the system, including insurance cards, data from personnel records, purchase orders, articles from medical journals, daily financial summaries and, of course, patients’ clinical records. “We never use a paper document unless a patient walks through the door with one,” says Stinnett.
Since going live with the software, the practice has never used a paper chart again. In fact, after completing a comprehensive backup of scanned charts, they shredded all their paper charts and turned the file storage room into a revenue-producing exam room.
Stinnett says the practice seriously considered how the surgeons used paper charts before selecting the Allscripts system and that they examined a number of systems before purchase. Unlike general practitioners, PSA surgeons didn’t actively use paper charts during patient exams. “The surgeons generally perform a hands-on exam,” says Stinnett, “and then they would leave the exam room and dictate their notes.” TouchChart gives them the functionality and automation they need, especially in terms of progress notes and dictation. “Originally, the physicians dictated their notes on tape; transcriptionists would type from them and e-mail them back. We uploaded them directly into the patients’ charts.”
Now, she says, the physicians have switched to PDAs, which support electronic transmittal of notes to the transcriptionist’s e-mail box. Since the enterprise has eliminated individual servers in all locations in favor of a centralized Citrix environment, the transcriptionist can type a doctor’s notes, code the documentation with the correct patient identifier and return it electronically to PSA. The system itself can organize the notes directly into the correct patient file and send a copy for the physician to review simultaneously.
Paper faxes are a thing of the past, too, with integrated fax software. All faxes enter PSA through an electronic cue. Nurses can toggle into the cue box, examine individual faxes and direct them to a specific physician, into the patient’s chart or into another staff member’s task basket–or all three at once. Information to be faxed to other physicians is electronically faxed directly from the patient’s chart.
Love Those File Cabinets
Availability of an electronic patient file has changed PSA’s whole staffing model, according to Stinnett. She is quick to point out that the benefits of an EMR system for a smaller practice extend beyond doctors and nurses, and that administrative, scheduling and financial staff also depend on having a usable system.
Some savings, she says, are obvious: Reduction in paper costs, chart maintenance and pulls, and copies of copies. “But the real savings come from the way the system has allowed us to manage our files as we work and thereby to change our workflow.” She describes, for example, a multifaceted, largely manual process required to change a patient’s appointment for a closed MRI to an open MRI without TouchChart. “This used to be a 15-minute process,” she says, “including telephone calls, chart pulls, faxes and more phone calls. Now, if this situation were to arise, I could handle everything electronically while I still have the patient on the phone. It would take two minutes top to bottom. How many times do you have to save 15 minutes of staff time before you recognize you have a winner? Not many. The average physician practice knows that.”
Stinnett also likes the system’s electronic file cabinets. “The whole filing system works like a database,” she says. “Whatever tabs or fields we need, we enter into the filing cabinet system, and then we can search and sort based on them. While this doesn’t affect patient charts, it does affect everything else we enter into the system,” from insurance data to personnel records to medical journal articles the physicians want to archive.
Stinnett says the practice is very satisfied with TouchChart’s security provisions. “It has been my experience that sometimes you want to give a staff member access, but not full access. TouchChart has separated levels of security. With some data, a user can see it, but it’s read-only. With other data, like behavioral health records, access can be severely restricted.”
Best of Breed Reigns
PSA is a best-of-breed shop. The practice uses a Misys practice management system and TouchChart on the clinical side. Despite the disparate systems, Stinnett says only four demographic fields actually require re-keying, and that office staff don’t want to change systems.
Premier Surgical Associates calculated a full return on investment within six months, including hardware, software and services. “It would have been near-instant,” says Stinnett, “except we had to buy all new hardware for everyone–computers, servers, everything. We didn’t even have a Windows environment before TouchChart.” Calculated into the return were elimination of two FTE positions that didn’t need to be refilled and the addition of the extra exam room.
Admittedly, Premier Surgical Associates is an old customer of the TouchChart technology. The practice has seen the product evolve over the years from a document management and workflow solution to technology that is template-driven and customizable by physician preference to meet the EMR needs of smaller practices.
With greater charting need and capability foreseeable in the future, Stinnett predicts that the physicians may eventually use tablets in the exam rooms with patients. But she’s not rushing.
“From the start, I liked this system because we didn’t have to alter our workflows to use it.” She says all the surgeons, from youngest to the oldest, use TouchChart with varying degrees of intensity. “Doctors don’t have to be computer literate to use it. When we started with this product, no one except me had more than 30 minutes of training on it. But employees loved it when they first saw it, long before they became experienced users.”
When it’s time to abandon paper and embrace the digital world, Stinnett has one piece of advice for fellow administrators, and it’s not about software. “Buy the fastest scanner you can afford.” The faster the scanner, the sooner the shredding begins.
For more information about TouchChart from Allscripts,
www.rsleads.com/601ht-203
© 2006 Nelson Publishing, Inc
January 2006
