EHR in the Doctor's Office

[Jaz-Michael King]

With the buzz building around electronic health records in the doctor's office, what are your experiences?

[Alicia S]

We are a small family practice with 2 physicians and 2 mid - level providers. About 18 months ago we embarked on an EMR implementation project for our office.
It takes a lot of time, committment, patience and stamina but over all, we love it. We have increased our complience tremendously. We were nominated and chosen for the 2004 IPRO award for excellence in patient care. It is definetly an obtainable goal for a small practice without costing an arm and leg if you are willing to do the grunt work.We would never go back to paper and actually we just archived all the paper charts to the basement and gained the extra space in the reception area. A few recommendations for anyone moving forward on this project.
1. Make sure all your staff, especially physicians are trained in basic computer skills. It will be difficult enough mastering the program, and learning a whole new concept in the way they practice medicine.
2. Make sure everyone is bored with the program before you go live. Nothing is more frustrating for the physician then treating a patient while trying to figure out how to order a lab test, or update PFSH.
3. Make sure everyone is committed, and do not set unrealistic goals. There are going to be hiccops and pot holes. Plan for them and breath deep.
4. Spend the necessary time customizing the program data prior to going live.
5. Allot extra time for the physicians the first week. Things will be slow in the beginning.
Alicia Shickle , CPC, RMM

[Jaz-Michael King]

Great advice Alicia, thanks! What were your experiences maintaining the system? Anyone else got any helpful tips?

(For people currently considering EMR/EHR, you may want to look at http://www.linuxmednews.com/linuxmednews/1087177825/index_html which lists a bunch of free and open source solutions.)

[Alicia S]

My experience in maintaining the system has been simplified by making sure the operating systems are powerful and have room to store a lot of data.
I have a schedule for routine file maintenence, defraging the systems etc.
My biggest advice here is: back-up, back-up, and back-up. Protecting the data is critical. Do not cut corners with the hardware to save a few bucks, it will cost you in the end.
I also install quarterly updates, and constantly monitor better ways to utilize the program's capabilities. Trouble shooting has become very minimal and usually occurs from user error.

Love it, or hate it the EMR is the way of the future, which is not so far off. I say better to be prepared before it becomes mandatory.

Alicia S

[Jaz-Michael King]

Has anyone evaluated or implemented an open source or free EHR/EMR system? I'd love to hear feedback on viability, usability and functionality.

[lmalone]

We have selected Allscripts as the vendor and have implemented Clinical Messaging and Order Entry. January is the date for implementation of all modules.

[Suzanne Columbus]

Thanks for posting to JENY and letting us know the system you have selected. Can you tell us a little about your practice and what the influencing factors were for your system selection.

Have you installed all the hardware in the practice yet? Are you going with tablet PC's, notebooks, desktops or a combination of all??

[schnakenberg]

We a 6 yrs with an EMR, we use the nextgen EMR,,
we do pay for performance, have seen the quality of care greatly improve
we redesigned the referal process using customized templates to reduce FTE time in processing a real ROi,
we are 100% transcription free, another ROI, using a mix of templates, free text, word document cut and paste, and when needed, human dicatation directrly into the note,, for uss the voice dictation fits in well but is to labor intensive to be wrth while
all our patients go HOME with their office notes, a joy for them and a recruiting message for the patients ,indirect roi as more folks join the electronic practice,
we have an intergrated level 3 lab so capture lab results into the EMR, the lab revenue helps keep down overhead, another ROI,
we run the practice as a care team, everyone uses thinkpads and has same technology available front desk,nursing, docs, by supporting everyones work flow we are able to keep the FTE/MD ratios down to 2.5 : 1, so this is a real ROI ( no medical records storage, rent or staff)
we use customized xray requesting which allows others to actually get the prior auths approved, this fress up my staff time in paperwork and makes xray ordering a breeze, an indirect ROI,
we use an intergrated superbill that captures billing data from point of care, so in an OV if I give a vaccine, dip a urine, do an ekg, order a lipid panel, all billable fees are captured, we also trigger the superbill to capture J codes for each vaccine ( a lost revenue before we did this) so our billing error rates are way down , an indirect ROI,
bottom line is we could not provide the level of care without the EMR, our next phase is E healthcare, where patients will have open access to the chart via secure web site, this opens up all possibilities in disease state mgt/p$p opportunities for our patients,

in redesign,,
eric schnakenberg, communitycare family medicine

[Jaz-Michael King]

I would love to hear more about patients going home with their office notes, could you elaborate?

[schnakenberg]

Patients leaving with the notes;

we relalized a few observstions;
we make a note 100% of the time so why not give it to patients at the time of vist, this accomplishes many things
1. gives patients a joy, they recognize the 'quality' in the care,, it helps us get informal referals and grow the practice as they tell their families /friends, more folks come to see us...........
2. creates new expectations,, patients anticipate their ov note, when they see other MD's and get nothing they see the differenc immediatley
3 reinforces the advise for tx we give,, i.e SNAP , saefty net antibiotic protocol,, the take home antibiotic for viral illneess,"" if worse with xyz conditions ok to use,"", most patients want an explaination, not and antibiotic, we cover both. patients appreciate that,
4. for complex vists, i.e diabtes,, they leave with all info, the ov note becomes a 'medical home, '( PMHX meds allergies, vaccines, last tests, social hx labs etc) so if they end up in an ER outof state the OV note is comprehensive
also they are more engaged in their care, they can 'talk the AIC language'
5. we are preparing our patients to expect E-care, since we have an EMR, all notes can be posted to a web site, they can access the notes etc their,
we plan to market this access with a annual PM/PYR fee, it is a way of improving care and getting reimbursed outside the insurance model of reduced fee for service,
as an fyi, we are able to do this so well we can handle rx's renewals, lab draw, vaccinations, tx plans, and everything that goes into an OV encounter, in 15 min, patient leaves with a OV note,, we leave the office right after the last patient,, could not do it w/o the EMR.

the idea to upcode E & M codes has not really been a driver for us, not a ROI we focus on , it is the quality driver that we keep upfront ,all else follows from that.
hope this helps
eric

[Jaz-Michael King]

"we make a note 100% of the time so why not give it to patients at the time of vist, this accomplishes many things"

Wow, you appear to be my dream doctor. I don't suppose you're anywhere near Brooklyn?