Cost savings from reduction of paper, filing and chart pulls
Integration of imaging, laboratory, hospital and consultant data
Performance improvement and disease tracking
In 1997, when Dr. Nitin Damle’s four physician practice at South County Internal Medicine in Wakefield, RI, implemented an EHR, it was considered visionary. Dr. Damle and his partner Dr. Paul Barratt saw the rest of the world embracing new technologies and believed their profession should be no different. "We believed that it was an inevitable necessity in healthcare as well. Paper record-keeping systems are very limiting. We saw potential to provide better quality care, to enhance our access to data which could be used for studies, to track disease trends and to see how well we take care of our patients."
“There is no advantage to using a prescription pad.”
Dr. Damle and Dr. Barratt served as physician champions for the office's EHR implementation. Damle advises that every office needs a physician point-person. "This should be someone who can learn quickly, and is willing to put in the hours." Adjusting to a new workflow will initially take time for all physicians. "The notion that you need to dedicate time to implement the system is absolutely a truth, but I feel that you should keep your patient volume unchanged through the transition. Jump in, and realize that for a few months you will spend several extra hours in the evenings and/or weekends at the office." Now, their practice is fully adopted with seven physicians and "would never go back to paper records."
Dr. Damle believes that CCHIT certification is an important element of EHR selection. While CCHIT does not currently test a system’s usability, "you know you have the nuts and bolts that you need. It mitigates risk and gives you the confidence to make a purchasing decision that meets certain criteria and industry standards."
Dr. Damle recommends thoroughly evaluating your hardware to find a system that best fits your needs. His practice chose to forgo portable tablets and installed PC’s in each of their 23 exam rooms, at work stations, and in every physician's office. "We decided we did not want to carry around a tablet. We wanted to sit down and open a chart, and we knew we were quicker using a keyboard." Adequate server and memory capabilities are not cheap but very important. "You want something that can move from screen to screen as quickly as you can think. You will have to invest money for such a system and periodically upgrade hardware and software."
Another key element to a successful launch is proper training of all providers and staff. The vendor must spend time to make providers and staff comfortable with basic operations and the system overall. "Vendor support is critical for implementation and ongoing operations. I believe you essentially will get what you pay for."
Design the EHR templates to match the way you think. "Complete your templates in the very beginning, because that is when you have the most energy. You can always modify them when necessary. Once templates are created for your most common visits, you will see immediate time savings." After templates were in place, the paper chart was used only for reference and to flag critical pieces of information. Dr. Damle's practice chose to hire someone to scan in critical components of the paper chart. After one or two visits of referencing it, they were able to file the paper charts away. "Make the transition quickly so you do not have to go back and forth."
One long-term goal of the practice was to set up laboratory interfaces. "While we did not do this initially due to cost constraints, as the system evolved we were able to import more outside information directly into the patient record. Over the past three to four years, we have connected with our own lab and three outside labs using daily downloads. We are able to download discharge summaries, consultations, and operative/procedure reports from our local hospital."
Dr. Damle says that while it is hard to quantify financial savings, "labor expense reduction has been significant. We have been able to save two to three full time equivalents or about 10 percent of our labor costs. We can quickly verify insurance information, and bill faster. We don’t need to file paper charts and staff can look up information at the point of service. Nurses and receptionists are easily able to view messages for laboratory and imaging results. This is a huge advantage."
They now benefit from a more complete record. "We can view history, the physical exam findings, and lab/imaging results with one click. We have set up reminders for screening, vaccinations, and preventative health measures, ostensibly increasing the quality of work, which is much more difficult to do with a paper chart."
Damle and the other providers at South County Internal Medicine also took advantage of e-prescribing right away. "It is more efficient than writing a prescription. Most importantly, it is there for the record and you can see the history very quickly. The system alerts you to drug interactions, side effects and contraindications. It also reduces the risk of error due to illegibility and patients are happy to make one trip to the pharmacy. There is no advantage to using a prescription pad."
Dr. Damle looks forward to increased interoperability and communication with other providers. "We need to get consulting doctors such as our most frequent referrals (cardiologists, urologists and gastroenterologists) to link with our EHR. This would allow us to download their notes and eliminate scanning of documents.
"We continue to track quality by collating data on patients with chronic diseases, such as diabetes and cardiovascular disease." The practice is also in the process of implementing an automatic kiosk check-in system where patients will be able to self-enter and correct demographic and clinical information at each visit, which will automatically populate the EHR. "This will further save staff time and streamline work flow."