Case Study

Improved patient outcomes
Enhanced documentation
More efficient and complete billing

Dr. Marco Ferretti, whose interest in technology started as a child, has been working with computers for over 30 years.  Since seeing an electronic medical record for the first time almost 15 years ago, his goal has been to have a practice with an EHR.  He first got the practice to start with electronic booking, and then to use "templates" in Microsoft Word for well child visits and sick visits.  Now, he has had a fully functional EHR for three years.  Dr. Ferretti was driven by his belief that an EHR would provide better patient care and that the industry was going to start offering incentives and higher reimbursement rates for physicians utilizing an EHR.  "I wasn't positive, but I felt the industry was moving in that direction," he says. "Now we know that certainly is the case."

Dr. Ferretti began going to vendor fairs to see how some of the different EHRs worked.  He helped Rhode Island Primary Care and Women and Infants hospital to evaluate EHRs for their organizations, then began to consider what was best for his practice.  "We had to replace our current billing system, and this seemed an ideal time to convert to an EHR.  The cost of a new billing system ($35,000) was almost the same cost as a whole new EHR ($50,000)."

The selection process had many pieces.  "We needed a program that we could customize to meet the needs of our practice and physician work flow. Not everyone uses the EHR in the same way—it comes down to how you work as an individual. Are you going to type, dictate, use speech recognition software, or use a tablet?  Are you going to use mostly preformatted templates or free text?  Does the EHR have the flexibility to let different individuals within a practice do things differently?"

Dr. Ferretti advises anyone selecting an EHR to create a short list of vendor questions and ask each vendor the same questions. "You want them to be specific and relevant to your workflow.  For example:

• How easy is it to access growth charts?
• Do the growth charts have height and weight on the same page?
• Can you plot BMI?
• How do you document developmental information?
• Can you import demographics and immunizations into your EHR?
• Does your EHR allow for easy customization of prescriptions?
• Does your EHR allow for liquid and/or complicated prescriptions?

Ultimately we selected eClinicalWorks EHR as our best fit."

Another significant factor in the system selection process is the cost: of software, hardware, ongoing licensing fees, support, and unexpected expenses.  To help space out the cost, East Bay got a short 5-year loan from a financial institution.  "We also qualified for incentive money from BCBS of RI.  Ultimately, our system has more than paid for itself.  Even within the first year we saw no net drop in our bottom line."

As East Bay went through the selection process, they spent a lot of time considering the best way to set up their exam rooms and how to use the new technology to strengthen rather than hinder doctor-patient relationships.  "We had a lot of space constraints and we knew that we did not want to sit behind a desk and type. We did not want the computer screen on a wall or have our backs to the patient.  We also asked, how do we keep the kids from playing with the computers when we are not in the room?  After much discussion we decided to purchase tablets because they were highly portable, and allowed us to sit next to patients and engage them with the computer.  The patient was now a part of the process and the potential barrier of the doctor being stuck with his head in a computer was avoided.  Now, every young child, and often their parents, comes over to see the screen and wants to see what we are doing.  This has helped to overcome any potential negative impact from the computer."

As with all new things, new technology has a learning curve for users.  It takes time to learn how to use and feel comfortable with a laptop, desktop, or tablet. "In many ways it is like being a 3rd year medical student all over again: how do you document a visit, where do you go to look up information, where is the problem list, how do you write a prescription? Initially it is awkward, but it quickly becomes second nature.  In our practice it took a month to begin to feel comfortable. After two months, even the least experienced user was fully comfortable and up to speed."

One of the things that helped the practice was a "fuzzy go-live." "We tried out the electronic record on a few patients the first day, then printed out the electronic visit and placed it in the paper chart.  Each day we got more comfortable and did more visits.  By the end of the first 2 months, we had all stopped using the paper charts and were documenting solely on the EHR."

Installing an EHR has benefitted Dr. Ferretti's office in many ways.  One advantage is that the EHR helps to improve documentation and patient care. "Documentation takes me slightly longer, but is more complete and helps improve the care I can give my patients.  We also receive reminders about vaccinations before each patient visit, and have access to those records where and when we need them."

The EHR has also allowed Dr. Ferretti's office to qualify for several financial incentives. "We have received several rebates from insurers, and one pays us at a higher reimbursement rate per patient." Thanks to more accurate coding, Dr. Ferretti’s office now misses fewer charges than when they used paper records. Other benefits the practice has experienced include "great patient forms and letters, electronic prescribing, disease tracking and outcomes management."

"We continue to improve our ability to electronically interface with additional labs, radiology, hospitals, and to the statewide information exchange, currentcare."