Case Study

Convenience of remote access to patient information
Financial gains
Accurate data tracking of family and past medical history

Dr. David M. Steigman, an internist in Providence, RI, has been in solo practice since 1990.  He began looking into EHRs in 2004, recognizing that since virtually every other industry had already made the switch from paper to electronic workflows, the healthcare industry would soon follow.  He was also motivated by his desire to analyze his own practice independent of the insurers, his sense that patients would increasingly expect computerized offices, and his own desire to take on a new challenge after more than a dozen years in practice.

Dr. Steigman began attending vendor fairs and community meetings hosted by organizations in Rhode Island.   He made his decision after hearing from physicians who were using EHRs, who helped him realize how much potential an EHR offered.  An office visit to a small group practice was also helpful, but Dr. Steigman found it difficult to judge different systems through demonstrations.  Once he made the decision to adopt an EHR, he relied heavily on others’ work to vet various systems, ultimately choosing eClinicalWorks.  As a solo practitioner with limited tech skills and no IT staff, having a server in his office was not an option.  He chose to implement the ASP, or web-hosted, version offered through the Lifespan Physician Service Organization (PSO).  "The ASP model was perfect for me," says Dr. Steigman.

Dr. Steigman has transitioned his practice from paper to electronic records over a 2 year period.  He has personally loaded the essential elements of every paper record into the EHR, creating comprehensive Personal Medication Histories, Problem Lists, Medication Lists, and Family Histories.  He then chose essential paper documents from each record for manual scanning—an approach that, although time-consuming, has allowed him to put the paper record aside forever.  In a few months, just over 2 years since beginning, his office will be completely converted.  Despite the increase in time, says Dr. Steigman, "It’s been a successful process and yes, utilizing an EHR has improved the overall efficiency of my practice." 

Dr. Steigman has begun to see financial improvements in several ways.  He has almost completely eliminated his transcription costs, which had been about $8-9,000 annually—not including the labor of pulling the last page from each dictated chart, packaging the pages for the transcriptionist twice weekly, and then refilling them.  This savings now more than covers his yearly EHR maintenance, which comes to about $4,700.  Dr. Steigman’s office has also benefitted from a $5,000 grant from BCBSRI as a primary care incentive for EHR adoption, as well as a $500/month for the first year, and now $400.00/month for the second year.  This was particularly important for the initial capital costs of hardware and license fees.  

Dr. Steigman and his staff have also achieved great gains by using the EHR's electronic scheduling system, interoffice messaging system, and the electronic handling of patient telephone calls.  "We used to have a paper notebook in which all the day’s messages were recorded by hand—prescriptions to be filled, patient problems that needed to be addressed, and so on.  I would look at that notebook innumerable times every day, making checkmarks to 'ok' a prescription, or writing out an answer to be given to a patient by my secretary, or making calls myself as necessary, throughout the day.  And more often than not, this involved the need to pull a chart.   Now it is all done electronically, seamlessly—messages show up on my screen, and without leaving my desk, I handle them as appropriate—making a call myself, messaging my secretary, or sending an e-script.  If I need to refer to a record, it is now only a click away in the patient’s EHR.  And everything is automatically recorded in the patient’s EHR.  No more paper and far superior record keeping, with much less labor for both me and my staff."

"The EHR has another benefit I did not expect: it has brought more organization and logic to my patient records.  I used to chart active medical problems together with 'inactive' medical problems, but I now use a separate 'Problem List' and 'Past Medical History'.  A history of migraines for instance, that has since become inactive, can be relegated to the PMH list, and the Problem List becomes what I deem the essential issues of that patient, which helps me focus on the essentials when I’m seeing the patient. It is more difficult to do this with a paper chart—at least it was for me."

"Patients clearly seem to equate technology with better quality. It is my strong sense that my patients appreciate the fact that my office is 'up to date' in this regard, and I think this gives them a further sense of confidence in the care they receive.  An EHR makes increased quality a possibility, if not a given!  One recent example comes to mind.  The ER called me at night about a patient of mine with atypical chest pain—at worst a soft 'rule out', but with some changes on her EKG.  I was able to pull up her chart from home, look at her EKG, and confirm over the phone that the EKG was unchanged.  This allowed the ER staff to send the patient home, saving an admission.  Blue Cross made back the money from the grant they’ve given me on that one case!"

Dr. Steigman is looking forward to the next level of advantages, including using the EHR for billing.  "I am looking forward to using the EHR to better understand my practice, to measure the various quality indicators that we all know about.  I also look forward to automating reminders and all the little things that add to the EHR's value.  When my office manager eventually retires, which she’s been threatening to do for the past 18 years, I am realizing that with the efficiencies of the EHR, I will be able to manage my office with just one person!  And though it will be like losing a family member, it will be a tremendous cost savings."