Significant financial gain by reducing paper based charts
Dramatic reduction in turnaround time for lab results
Increased average charge per patient due to better documentation
Dr. Pablo Rodriquez is President and CEO of Women’s Care. He runs a multi-site practice that provides a full continuum of health care to women in southeastern New England. He and his team of 18 providers struggled with the high administrative and clerical overhead costs that it takes to run paper-based offices, including the costs of tracking 56,000 patient visits with paper clips, liners, and files.
Dr. Rodriquez recognized that most of the staff’s time was spent filling out forms and tracking down patient information. That became the primary motivation for moving to an EHR – improve patient care by tracking patients more carefully, quickly, and accurately, and by better capturing and reporting quality measures. Looking back to when they first began the EHR implementation process, Dr. Rodriquez can confidently say that is just what they’ve been able to accomplish.
“We were afraid to move to an EHR because we thought we were going to spend a lot of money and not get an immediate return. The surprise to all of us was that we started saving money immediately, not to mention gaining space and no longer feeling overwhelmed with folders, papers, and charts.”
Women’s Care was grateful to be selected by Blue Cross and Blue Shield of Rhode Island to participate in their Quality Counts program, which helps practices fund the adoption of EHRs and includes bonus payments over a three year period. As a participant in the program, Dr. Rodriquez and his leadership team set out to deploy an EHR that would 1) reduce administrative costs, 2) reduce paper-based costs, 3) increase productivity, and 4) improve patient care.
The team chose to implement CareTracker EMR and integrate it into its existing billing and scheduling system. Unlike traditional client/server based EHRs, CareTracker utilizes the Application Service Provider (ASP) model, which can be accessed through a computer using a secure web interface and is paid for with a monthly subscription cost. Once logged in physicians would be connected to their patients’ labs, pharmacies, partnering physicians and hospitals. “The ASP model was the best choice for us because we did not want to invest in IT staff or maintain networks or servers.”
As the physician champion in his office, Dr. Rodriquez emphasized three factors in their successful implementation:
1. Develop common nomenclature. “Create a system using procedure names and date ranges for online filing to help you stay organized. If something is misfiled on paper you can probably find it again, but on the computer you will never find it.”
2. Name physician champions. “You must have at least one champion in each office that knows the software inside and out and that can fix a computer.”
3. Implement using a “Phased-in approach.” “We staggered the EHR according to patient profiles between April 2008 and March 2009. All we did for the first three months was use the EHR for gynecology patients. We started with brand new BCBSRI patients that had no paper charts. Then we moved to new patients with all insurances, to annual patients, and finally to new obstetrician patients. Working cold turkey is too disruptive and can lead to an unhappy staff. This schedule gave our staff time to react to the change and not feel threatened by it.”
“We were afraid to move to an EHR because we thought we were going to spend a lot of money and not get an immediate return. The surprise to all of us was that we started saving money immediately, not to mention gaining space and no longer feeling overwhelmed with folders, papers, and charts.” Less than a year after their transition, Women’s Care experienced the following benefits:
Overall, Women’s Care will gain financially from the use of their EHR and will realize an estimated, cumulative five-year net benefit of $262,085 with a return on investment of 95% and a payback period of four months.
“The bottom line for Women’s Care, though, goes far beyond financial payback – it is in improved patient care,” says Dr. Pablo Rodriquez.
We would like to communicate with our patients securely through a patient portal where patients could interact with providers via reminders, test results and be directed to educational materials. Such a portal could also serve as a disease management system that could allow patients to keep track of their blood sugar, cholesterol, and blood pressure for example, and incorporate that data into their record. Though I have seen a prototype and there is language around patient portals in the meaningful use regulations, you can't do this without a culturally and linguistic system of communication.