For many physicians, the goal of implementing an electronic medical record (EMR) is to rid themselves of paper. While the paperless office is considered the ideal healthcare environment, the reality is that it can result in unintended consequences that can impair an office’s efficiency instead of improving it. Why? Because, EMR technology does not automatically enhance every business or clinical process. Furthermore, it’s difficult for offices to achieve the efficiencies associated with a zero-paper environment due to trading partners such as specialists, hospitals and insurers that not only submit, but also request, a large amount of paper documents.

Doctor’s Walk-in Clinics, an urgent care chain serving a three-county area of more than 2 million residents, was faced with the challenge of providing quality medical care with minimal waiting time at a reasonable cost for its walk-in patients. Established in 1980, the company had grown to seven clinics throughout the Tampa Bay region in Florida, each offering extended hours, seven days-a-week operation, and comprehensive services including X-rays and EKG testing and analysis. As the influx of patients continued to increase in the typically unpredictable manner of walk-ins, the clinics struggled to balance the resources of its 37 full-time and part-time physicians. To optimize resource allocation and minimize the costs for their facilities and the patients, the clinics decided to investigate the benefits of an EMR.

The Paper Chase

“If a patient went to a different clinic for a follow-up visit, that clinic’s staff would have to call the first clinic to request that the patient’s chart be faxed prior to the visit,” says Jason Dickey, vice president of marketing and business development at Doctor’s Walk-in Clinics. “Employees spent hours chasing and faxing paper charts from clinic to clinic. It was inefficient at best. At worst, it was a tremendous waste of time and resources when staff had to call other locations to track down charts.”

Today, all physicians and 240 employees at Doctor’s Walk-in Clinics use the EMR to access and manage critical patient data, enabling improved clinical decision-making and more accurate documentation of patient encounters, which has led to increased reimbursements that reflect the extensive patient care delivered.

State regulations also required that patient records be stored for seven years, the compliance with which presented two challenges: 1) Many of the patients were infrequent visitors; and, 2) The clinics had limited storage space. To comply, Doctor’s Walk-in Clinics shipped their records to an offsite storage facility after one year. Thus, if a patient came in a year after their initial visit, Doctor’s Walk-in Clinics had to process a completely new chart for them rather than retrieve their old chart, which would have also required a removal fee. This decreased staff efficiency and patient care.

Billing also was problematic. Every day, each clinic would copy the charts and courier the duplicates to the centralized billing department at the Doctor’s Walk-in Clinics’ headquarters. After receiving the charts, the company’s 11 billers labored to decipher physicians’ handwriting, extending the already time-consuming billing and chart auditing process.

Seeing the Light

Doctor’s Walk-in Clinics began their search for an EMR solution that was easy to use, flexible and customizable to address the needs of diverse specialties. A five-person EMR selection committee solicited recommendations from similar facilities, checked references and performed onsite visits to see various EMR solutions in action. Next, the company arranged for four vendors to demonstrate their products in person. This thorough evaluation took nine months, after which, the committee collectively recommended MediNotes e from MediNotes Corp.

In the spring of 2006, Stephen F. Dickey, M.D., a family and emergency medicine physician who is also president, CEO and owner of Doctor’s Walk-in Clinics, accepted the recommendation and the implementation race was on.

Ready … Set … Stop

Doctor’s Walk-in Clinics elected to deploy the new EMR in a phased manner. Initially, the company selected a new clinic as the first site, but was forced to halt the implementation within two days because the physicians found the templates too difficult to operate. Returning to the drawing board, Doctor’s Walk-in Clinics took the extra steps to customize the templates to mirror the physicians’ workflow and their current paper chart format, reducing the learning curve and increasing adoption rates. They also discovered that many of the staff still had a need for a paper-based superbill, which was often used as a valuable “quick check” on the patient’s location and current treatment. With these adjustments in place, Doctor’s Walk-in Clinics restarted its phased EMR rollout.

To support the EMR launch, a Doctor’s Walk-in Clinics’ employee became a MediNotes trainer and spent one month training each clinic’s physicians and staff. Although the trainees had varying computer skills, everyone became proficient on the EMR due to its now-familiar template. Typically, we completed the individual clinic deployments within two months, and within 14 months, installed the EMR across the entire enterprise.

Today, all physicians and 240 employees at Doctor’s Walk-in Clinics use the EMR to access and manage critical patient data, enabling improved clinical decision-making and more accurate documentation of patient encounters, which has led to increased reimbursements that reflect the extensive patient care delivered.

Quantifiable Cost Savings

Prior to implementing the EMR, Doctor’s Walk-in Clinics paid two separate fees totaling $12 to $15 whenever it had to remove and return a record to the storage facility. The company cut that cost in half by scanning patient records into the EMR and destroying the original chart afterwards, rather than returning it to storage. Furthermore, Doctor’s Walk-in Clinics saved approximately 12 hours per week by eliminating faxes and other paper-related costs, which equates to approximately $6,000 to $7,500 annually.

Every day, each clinic would copy the charts and courier the duplicates to the centralized billing department at the Doctor’s Walk-in Clinics’ headquarters. After receiving the charts, the company’s 11 billers labored to decipher physicians’ handwriting, extending the already time-consuming billing and chart auditing process.

“We anticipated that an EMR would improve information sharing among our clinics and provide physicians with access to a centralized source of patient information,” Dickey says. “What we didn’t anticipate were the other added benefits, such as improving our prescription methods. The computer-generated prescriptions have helped us to communicate better with pharmacies, and prescriptions are legible 100 percent of the time.”

The EMR sharply boosted the productivity of Doctor’s Walk-in Clinics’ 11-person billing department, saving one day of work per week per worker. “Our billers can now easily read, review and audit charts online instead of sorting and struggling to read paper charts,” says Dickey. “They perform their jobs much more quickly and efficiently than before, and can dedicate more time toward collecting rather than billing.”

Doctor’s Walk-in Clinics also expect additional savings. As of April 2012, the legal obligation to retain medical records expires, allowing the company to dispose of records created prior to the EMR’s rollout, eliminating a $1,750 monthly cost for medical records storage.

“We’ve realized that intangible benefits are often difficult to measure,” says Dickey. “Now, our corporate office can analyze the data and determine whether any of the clinics have unusually high wait times, enabling us to identify problems and better allocate resources by dispatching back-up physicians to clinics that are short-handed.”

Moreover, the EMR is now interfaced with Doctor’s Walk-in Clinics’ practice management system, enabling physicians and staff to immediately discuss treatment plans and charges when patients call. This enhanced customer service should result in additional referrals and repeat patient visits, augmenting future revenue sources.

Tony Thompson is director of IT at Tampa, Fla.-based Doctor’s Walk-in Clinics. Contact him at [email protected].

May 2008