Remember the good old days? I do, and not everything was that good. When I started post-college work, I had no calculator, no personal computer with Excel or word-processing software, no fax machine, no internet access, and no smartphone. I love technology, so I have been amazed by and embraced advances that have come along as the years have passed.
Several years ago, I heard a compelling keynote address by Newt Gingrich at the Medical Group Management Association (MGMA) national conference. He shamed us with our slow progress into the electronic medical record (EMR) arena. Using banking as an example, he reminded us how we use our credit and debit cards everywhere in this country or worldwide, have online bill pay and account access, yet we are satisfied operating with paper charts from practice to practice, with no electronic connectivity—dinosaurs in a modern world.
Before and after that speech, I have attended many talks and listened to early adopters of EMRs, which morphed into electronic health records (EHRs) during this extended time span.
So, why was our group so slow to move into this exciting technology? Most of our 9 physicians were satisfied with paper charts. To me, jumping in seemed expensive in more ways than one. Not only was the actual cost high with an exorbitant time commitment, companies were going into business with a splash but were then bought or were out of business a few years later. Then there were the anecdotal stories that persisted of a necessary employment change after leading a less-than-ideal EHR implementation.
No matter what your politics, I believe the game change came with the American Recovery and Reinvestment Act of 2009. Significant monies became available to eligible professionals to help fund the cost of an EHR and with this, the hammer of a Medicare penalty if you did not adopt a certified, meaningfully used EHR by 2015. I saw that this was the time to push us forward and pursue an EHR.
In early 2010, I presented 2 oncology-specific “cloud” EHRs to our physicians to choose from. The upfront cost for these choices was significantly less than EHRs housed on-site, with practice-owned hardware. This also enabled us to keep our current server room intact without additional space requirements. Updates would be done automatically in the cloud during off hours, with no interruption to the practice. Again, learning from others who had already implemented an EHR and shared their wisdom, I chose an oncology-specific system, knowing, among other things, that the regimen library would already be built for most protocols and be updated as new drugs entered the market. This would be a huge time-saver. In the end, our physicians opted for the iKnowMed EHR offered by McKesson.
With the decision made and the contract signed, time moved along as we went through biweekly phone implementation planning meetings and made necessary decisions along the way as we neared a go-live date in January 2012. I was hopeful, yet skeptical, that only a 2-week reduced schedule was indeed needed with this program. I had heard and read so many times to plan on 6 months or up to a year of lost productivity. But we were assured it would be better than that.
We are 6 weeks past our go-live date, and physician-patient productivity was in fact down only a few weeks. As with all new systems, physicians spend extra hours loading patient information for first visits in the EHRs, but that will end in time. I walked around the office yesterday and did not see “train wrecks” in the various departments but rather smiles. Our staff is still learning, but they like the chosen product and see many benefits versus our paper-only days already. The benefits we are seeing now, or will see in the near future, are:
- Legibility. A huge benefit already enjoyed by most of our staff, instead of stopping to ask questions about what was written, the information is clearly presented, which impacts questions about prescriptions or physician and scheduling orders.
- The hunt for charts is over. This is self-evident.
- Concurrent record use. Physicians, nursing, medical records, scheduling, or other staff can all be in the same patient chart doing various tasks concurrently. This is an incredible efficiency benefit.
- Physician access 24/7 from home and the hospital. A physician can check patient information, look at his or her queue, sign off on laboratories or other tests, and dictate and write orders from a convenient location outside of the office. This is a major improvement from paper charts confined within a facility or removed from the facility.
- Improved use of staff time. With paper charts, nurses and other staff were often standing outside an examination room waiting to ask a physician about a patient for treatment, triage, scheduling, or billing issues. With the queue system built into the EHR, staff no longer need to waste precious time in the hall.
- Patient portal. We will be going on the newly available patient portal as soon as possible. Not only will this help us with some meaningful-use criteria, but again it will save staff time (eg, calling patients with normal results).
- Portability of records. Electronically sending encrypted patient information across town or across the country is another positive EHR benefit. This saves faxing chart records or copying and mailing this information to patients being referred for other medical treatment or for the treatment of mobile patients spending parts of the year outside the area.
- Future area health information exchange (HIE). We are working with several larger groups and are hopeful that HIE will be up and running in central Ohio within the next few years to exchange patient data, thus avoiding test duplication and many other safety or cost-saving benefits to the patient and, ultimately, for total healthcare costs.
- Privacy of patient records. Paper records can be stolen, misplaced, looked at by improper staff, or gone altogether as a result of a natural disaster. EHRs are only accessible by staff at specific and appropriate levels.
- Offsite backups of records prevent the likelihood of a total destruction of irreplaceable patient information.
- Patient drug interactions are flagged. A good electronic system will flag drug interactions, saving the patient a potential medical problem.
- Transcription. Dragon’s medical transcription oncology module is being used by all of our physicians since our go-live date. This is saving our group more than $125,000 in annual outside transcription costs. We kept our 1 internal transcriptionist who edits as needed and continues our practice of electronically faxing letters and notes to our referring physicians.
- Staff time. Interfaces in place, or soon to be in place, bring all laboratories and key hospital testing directly into the patient’s electronic chart with a queue message for the physician to sign off on the new information. This saves significant amounts of staff time putting paper results on the physician desk and later picking up and filing the signed-off result.
- Supplies. With the EHR, we do not have paper laboratories or key hospital information coming by fax or mail. In fact, paper use is down, a dollar savings to the practice and of trees for the environment. Equipment toners and general wear are also reduced.
- Data mining made easy. We can run reports by diagnosis, drugs, age, or almost any data for use by the physicians as they research and continue to seek improvements in patient care.
Finally, I am happy that we are on this side of our go-live date. It has been a positive experience, with only minimal bumps along the way. I met with our medical protective malpractice agent recently, and I found that we will get a 2.5% credit off of each physician’s premium next year and in future years, because we have this certified technology. It took us a long time to have an EHR, but it certainly was the right step for us as a medical practice in the twenty-first century.