A Kansas City practice saves time, money and space with an EMR.
In the fast-paced world of patient care, most large medical practices face the challenge of effectively and efficiently handling the massive amounts of patient data and administrative documents. To deliver high quality care, physicians and administrators must be able to constantly access the patient information they need, when they need it. At OrthoKC, a Kansas City-based orthopedic practice specializing in joint reconstruction and sports medicine, our paper-based records were creating obstacles to achieving that goal, wasting unacceptable amounts of time and money
A Kansas City practice saves time, money and space with an EMR.
In the fast-paced world of patient care, most large medical practices face the challenge of effectively and efficiently handling the massive amounts of patient data and administrative documents. To deliver high quality care, physicians and administrators must be able to constantly access the patient information they need, when they need it. At OrthoKC, a Kansas City-based orthopedic practice specializing in joint reconstruction and sports medicine, our paper-based records were creating obstacles to achieving that goal, wasting unacceptable amounts of time and money.
OrthoKC sees approximately 150 to 200 patients each day, with the practice handling more than quadruple that number of patient charts daily. In 2005, we had 40,000 patient encounters, with an estimated 1,800 hours spent in chart handling alone. We estimated that necessary information searches for scheduling, prescription refills, patient visits and responses to patients’ phone-in questions were costing us the equivalent of one full-time employee. This challenge was further compounded by difficulties in finding and tracking lab/MRI reports and other critical items in a timely manner. It was evident we needed a more efficient way to handle our patient data—one that would reduce time and costs.
We initially began our search for an electronic medical record (EMR) solution by forming a diversified team to research our options. During this initial period, the team consulted frequently with the doctors and staff about their top concerns. Doctors were concerned about a system that would slow them down or get between them and the patients while primary staff concerns centered on losing their paper and known workflows.
Our first step in the selection process was careful review of available solutions for simplicity and ease of administration. Most EMR solutions we evaluated utilized a point-and-click selection process or templating processes where every medical note essentially had to be the same. This would drastically slow down the process for orthopedic surgeons. Many of the possible solutions offered a working prescription program that required an additional purchase through a second party vendor. Overall, we needed something that allowed simple and easy creation and scanning of forms with a look and feel that fit our specifications and EMR standards without additional cost. We chose Impact.MD, a medical document management solution from Allscripts.
By combining the best of our paper-based systems with the new electronic systems, our physicians were able to retain the familiar standardized paper charge slips and intake forms that enable them to keep the personal touch when talking with patients.
Training and Rollout
The rollout process began with scanning charts and creating electronic file cabinets for non-patient data. We introduced the system to a new doctor starting every two weeks. The electronic file cabinets and OCR (optical character recognition) features enabled billing staff to immediately search for explanation of benefits (EOB) and documents in the patient charts. By the end of the first month, we had added tasking, with Allscript’s prescription module (Impact.Rx) added two weeks later. We successfully rolled out several Impact.MD modules in only two months, with physicians and staff quickly trained in the key technologies and moving seamlessly from paper to digital files without missing a beat.
We scanned all charts of patients that had been seen since January of 2005. Additionally, we devised a resource-efficient approach that allowed us to retain essential paper forms that complement the functionality of the electronic system. The functionality of electronic file cabinets and OCR within the Allscripts solution was also superior for finding misfiled reports or even EOBs through the use of the audit feature. This feature tracks every viewing, printing and filing of a document in the system by user. This became indispensable, as there were questions on where a document was filed and what to name it with the initial changeover from paper to electronic documentation.
When a staff member misfiled a document, we could use the Allscripts audit feature to see who filed the document and then use it as a learning tool. This decreased the frequency of errors because we could bring it to the attention of the individual rather than sending a blanket memo telling everyone what is being filed incorrectly. We soon found the system could be used for other things as well, such as copying insurance contracts, fee schedules and manuals into a file cabinet that can be searched and viewed by any staff member. We also can limit access to patient chart areas and file cabinet access by user or user group.
The Bottom Line
Our transition to electronic records has already boosted our productivity by almost 25 percent, and that’s just the beginning. We’ve decreased overtime by up to 14 hours a week, and have achieved a staff-to-doctor ratio of less than four to one, which is considered extremely low for an orthopedic practice. Additionally, when a full-time employee retired recently, we did not need to refill that position.
Other savings benefits included an expected savings of over $24,000 yearly on chart-related costs, and an extra $12,000 in shelving expenses. We’ve scanned over 750,000 pages (including more than 180,000 administrative documents stored now in electronic file cabinets) and anticipate that 400 square feet of storage space will soon be freed up for other purposes. Furthermore, billing and appeals are much faster, denials have dropped, and we realized a noticeable decrease in A/R turnaround time within the first two months.
We estimated that necessary information searches for scheduling, prescription refills, patient visits and responses to patients’ phone-in questions were costing us the equivalent of one full-time employee.
With the adoption of Impact.MD modules for document management, electronic medical forms, scanning, archiving and electronic prescribing, the office runs more productively. Lab/MRI results are available almost immediately—they’re in the chart at least three days sooner. Additionally, information can be reviewed at the physician’s convenience, whether at the office or from home, by remote access. When system questions have arisen, the phone support has been prompt and thorough, unlike some of our other systems where questions can take days to be answered.
Less Paperwork, More Care
By combining the best of our paper-based systems with the new electronic systems, our physicians were able to retain the familiar standardized paper charge slips and intake forms that enable them to keep the personal touch when talking with patients. These forms help physicians avoid some of the physical inconveniences of computers, such as having to turn away from a patient to enter data, or place the computer in front of them, which can cause awkwardness during the patient visit—especially important in orthopedics and other “hands on” or procedurally intense specialties. These forms also help physicians with their dictation later in the day and provide a useful backup without significant paper accumulation.
One of the big benefits of the new system has been the significantly reduced level of anxiety around the office. Since charts, lab results and other essential information can be accessed immediately, there is less redundancy and chaos, making the office environment quieter and more relaxed—a big plus for physicians, staff and patients. These kinds of benefits stand above and beyond savings in time and money. We now thrive in our efficient, near-paperless office and can’t imagine looking back.
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APRIL 2007
