A small family practice reaps the benefits of a Web-based EHR.
It has been three years since President Bush introduced his health information technology initiative mandating that all healthcare providers and institutions implement an electronic health record solution (EHR) within one decade. So far, EHR implementation has been slow for one- and two-physician practices, which account for more than half of all practices in the United States. Rural practices, in particular, face more challenges in transitioning from paper records to a high-tech solution.
A small family practice reaps the benefits of a Web-based EHR.
It has been three years since President Bush introduced his health information technology initiative mandating that all healthcare providers and institutions implement an electronic health record solution (EHR) within one decade. So far, EHR implementation has been slow for one- and two-physician practices, which account for more than half of all practices in the United States. Rural practices, in particular, face more challenges in transitioning from paper records to a high-tech solution.
In 2004, I established Total Health of Iowa, a two-physician family practice based in rural Hudson, Iowa (population 2,000) that racks up 13,000 patient visits per year. With previous experience running a medical practice in the early 1990s, the decision to make the leap from paper records to an EHR was a no-brainer. I realized the benefits an EHR could provide to our main office in Hudson and our satellite location in Reinbeck, Iowa, just 20 miles away.
An EHR would enable Total Health of Iowa to leverage our physicians’ time to do more with greater speed and accuracy, which has an impact on the quality of care we can provide to our patients. The key was finding an affordable, HIPAA-compliant EHR with an integrated practice management (PM) system designed specifically for a small practice. It also had to be user friendly for our staff of seven: two physicians, two billing employees (one in each office) and three nurses.
The Issue
For more information on the EHR solution from MedPlexus Inc.
Small practices, such as Total Health of Iowa, cannot afford the overhead, complexity and downtime associated with systems that are designed to meet the needs of larger clinics. In addition, our medical staff did not have knowledge and expertise in maintaining the hardware, system software and database administration associated with larger systems.
Converting our staff to a high-tech system that enabled them to access and share information from our two practice locations via a virtual private network posed problems because we were used to doing things the old-fashioned way. The solution was to identify and implement an easy-to-use, Web-based integrated solution that combines technology and services.
The Solution
When I heard about Partners for Patients, the American Academy of Family Physicians’ (AAFP) pilot program for EHR implementation in small family physician practices, my interest was piqued. The project, headed by David C. Kibbe, M.D., director of AAFP’s Center for Health Information Technology, was a real-world laboratory where family physicians worked together with some of the very best and innovative IT companies to help design a low-cost, standards-based EHR option that could eventually be used by thousands of practices.
After one week, the entire staff was trained and the EHR went live. We now use templates and voice recognition, enabling doctors to be more accurate in entering information into the computer.
The family physicians also learned how to overcome problems with implementation, connectivity and training. Six family practices from around the country, in addition to physicians and technical support teams from MedPlexus Inc., Hewlett-Packard, and Siemens Solutions Health Services Corp., immersed themselves in the year-long program, which started in January 2004. When I contacted Doctor Kibbe to discuss an EHR system for Total Health of Iowa, he gave me three recommendations, including MedPlexus, a Web-based integrated solution that combines technology and services for a monthly fee.
We chose MedPlexus because, for an affordable monthly subscription rate, its Software-as-a-Service (SaaS) delivery model keeps physicians continually up-to-date with the newest standards, compliance and features.
Implementation and Training
The computer equipment, installation and training for Total Health of Iowa’s two locations cost $16,000, plus an $870 monthly fee for using the Web-based software, which includes maintenance, scalability, reliability, disaster recovery, privacy and data security.
We definitely experienced a learning curve in using the EHR system. It was a challenge to get the staff at Total Health of Iowa, who were used to dictation and transcriptions, to make the switch to an EHR. The vendor provided four hours of group training and individual sessions via Webex, and support was available by phone after the initial training.
After one week, the entire staff was trained and the EHR went live. We now use templates and voice recognition, enabling doctors to be more accurate in entering information into the computer. Beyond initial training, physicians and staff explored other functionalities as their comfort level increased.
The key was finding an affordable, HIPAA-compliant EHR with an integrated practice management system designed specifically for a small practice.
Bottom-line Benefits
As pleased as we were with the implementation after achieving a comfort level, we were even more delighted when we began seeing the benefits of converting to a Web-based EHR in the following areas:
Billing: By switching to an integrated EHR/PM, Total Health of Iowa saves $100,000 per year in billing functions. In the past, there were multiple people who handled billing, collections, posting, answering phones and scheduling appointments. Now, one person handles it all.
Cash flow: By implementing the EHR, every patient that is seen today will be billed tomorrow. Our billing person puts the charges into the system in 30 minutes, so patients receive bills in a timely fashion.
Transcription costs: The practice also reaped enormous savings by eliminating transcription costs, which used to be 16 cents per line, or $3,000 per year. Now, transcription is included at no additional cost. The practice saves more in dictation and transcriptions than what the system costs.
Prescription refills: Instead of faxing prescriptions to the pharmacy a nurse just clicks on “refill,” “pharmacy” and then “fill.” It used to take two to three minutes to order a prescription refill, which now only takes 15 to 20 seconds. The EHR automatically documents the prescription on the patient’s record and triggers a reminder to schedule patient appointments when necessary, enabling doctors to monitor when their patients start and stop taking medications.
Remote access: Our doctors can now access medical records from any location (e.g., office, home, hotel room) to review a patient’s history, post notes to a chart and review lab results.
Documentation: The EHR provides a convenient listing of a patient’s current medications, plus a chronological history of all past medications.
Scanning and uploading information: Lab results can be scanned into the EHR. The doctors also can use a digital camera to take photos of rashes, lesions and lacerations and upload them into the patient’s chart.
Chart printouts: Patient satisfaction has increased because physicians can give patients printouts of their charts.
It’s a big step to move to an EHR, but we would never go back to our old system. Our new system is continually evolving and updated every two to three months. When we started, we did not have prescription and faxing functions. Who knows what additional capabilities we will tap into as we learn and grow with our practice?
DECEMBER 2007
