TO EMR OR TO NOT EMR

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TO EMR OR TO NOT EMR

• That is probably no longer the question.

2
WHEN TO EMR?

• At some point most office will have to adopt some
  form of Electronic Medical Record.
• By planning ahead you can make the process less
  painful.
• Many of these processes you may already have
  implemented.

3
HOLT FAMILY PRACTICE

• We are a small group practice in a bedroom
  community of Lansing.
• 4 1/4 Physicians and 1 Physician Assistant.
• Practice started in 1979.
• We launched our EMR in December 2003.

4
We had discussed the possibility of moving to an
EMR over the past several years and the cost
seemed prohibitive. Things were working OK doing
things the way we were doing them. There did not
seem to be enough benefits to justify the
expense.
Then in 2002 we hired a new partner to help
replace our senior partner who had cut back. He
brought with him about 800 charts.
We were out of room. Looking at a 50,000
building expansion made an EMR look more
attractive.
5
PLAN AHEAD

• Organizing your charts can make the transition
  easier.
• Having a good Problem List and Medication list
  can make it so you can quickly get started
  entering patients.
• Decide where you are going to put the paper
  charts. Onsite vs. Offsite.

6
PLAN AHEAD

• Spread some of the Equipment purchases over a
  couple of years. Thus lessening the financial
  strain.
• Find out what equipment you are likely to need
  for any EMR and let that guide your purchases.

7
LOOK AT OTHER OFFICES

• If there are office near by that have an ERM it
  can be helpful to make a site visit and get a
  feel for an office that has an Electronic Chart.
  This can help you visualize this type of system
  in your office.
• Road Trip.

8
HOW WE WENT ABOUT IT

• We had a Practice Management system that used
  Dummy Terminals
• We began replacing them with PCs a few at a time.
  This allowed us to continue our old system and
  prepare for the future. By 2003 We had already
  replaced all of our Front Office and Billing
  Department terminals with PCs.

9
HOW WE WENT ABOUT IT

• Watch for salesI found that Dell cuts its prices
  significantly at the end of the year. So if you
  figure what you might need and watch their site
  you can save by buying after Christmas.
• Dell also has a Health Care site that does give
  you somewhat of a discount.

10
HOW WE WENT ABOUT IT

• We looked at several different products and
  finally settled on A4 now part of Allscripts.
• There were several reasons
• Cost.
• Ease of Customization.
• Several other sites fairly close so we could look
  at others using the software.
• Integration with P.M. software.

11
HOW WE WENT ABOUT IT

• We found out what equipment was compatible and
  purchased the provider and nursing laptops in
  2002, again spreading the cost over several
  years.
• We contracted locally for pulling wires, etc.
• We started with a minimum set of equipment
  planning on expanding. We have since purchased
  several printers and desktops.

12
HOW WE WENT ABOUT IT

• We have an unfinished portion of our basement so
  we have the luxury of keeping our paper charts on
  site. This eliminated any storage costs and
  allowed us to reduce what we felt we had to scan.
  We still pull a paper chart occasionally to
  scan more items.

13
THE PEOPLE

• Not everyone will be in the same place.
• Opting out is not an option.
• You have to have a champion. This will probably
  be the office Geek TechnoDoc. If that is you
  then you will have to take a Patience Pill
• Get an idea of everyones level of computer
  comfort. There will be a big range.

14
THE CHARTS

• We elected to scan only the last 3 yrs progress
  notes and just the most recent studies, labs,
  xrays etc. We scanned the last 3 yrs of consults
  when the patient had more in the paper chart.
• We entered people as we went along by entering
  problem list and meds as well as scanning about 4
  days in advance. Then recheck the day before.

15
THE CHARTS

• We brought the paper chart into the room as well
  for the first 2-3 visits then would mark it so it
  did not need to be pulled again.
• After 2 1/2 years we moved all our paper charts
  to the basement. We still see people that have
  not been entered so we grab their chart see the
  patient and then they get entered after the
  appointment.

16
THE COST

• Emotional.
• Time. Providers and Staff.
• Financial.

17
THE COST

• EQUIPMENT 45,000
• SOFTWARE 66,000
• STARTUP 20,000
• TOTAL 131,000
• Startup includes training both at A4 and onsite
  as well as equipment installation and setup.

18
THE COST

• Productivity will be down for the first 4-6
  months and should be back to at least pre EMR
  levels by the second half of the year.
• Different individuals will be up to speed at
  different times as they will have different
  comfort levels.
• We have not reached a level of productivity above
  our Pre-EMR level.

19
THE COST

• It will be stressful and initially the days will
  be longer.
• There were a few tears and maybe a few
  explicatives, but no body quit and by October
  even the people least comfortable at the start
  admitted they would not go back to the old way.

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THE BENEFITS

• THERE IS NEVER A LOST CHART.
• Remote access. You can securely access the EMR
  from anywhere you can get remote access. This
  allows you to finish charting at home after
  hours. Review a patients chart the day before
  their visit. Access your chart while you are
  admitting someone at the hospital.

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THE BENEFITS

• Labs come directly into the chart as they are
  done.
• When a consult, path report, or other test
  results are received you can immediately look in
  the patients chart. You no longer have to wait
  for a chart pull.
• Internal messaging is essentially email and can
  be handled just as fast.

22
THE BENEFITS

• Prescription refills are handled right on the
  patients medication list.
• Faxing prescriptions and E-Prescribe even to
  PBMs like Medco. You cant believe how much time
  this saves and the patients really like this
  cool feature.

23
THE BENEFITS

• There is data out there about increasing the
  number of 99214 visits that you will do in a day.
  This will depend on how much your practice had
  been working on this level of coding before your
  implementation. We had been aggressively training
  ourselves for several years. We have seen a minor
  increase for our physicians and a greater
  increase for our Mid-levels. We also all feel
  more comfortable with our coding as it is all
  checked by the EMR software,

24
THE BENEFITS

• Our financials have mostly improved in staff
  costs.
• We used to dictate 85 of our visits.
• We had several people whose jobs were purely
  related to the paper chart either finding it,
  running it, or filing paper.

25
THE BENEFITS

• The direct interface from the EMR to the PM has
  allowed us to reduce our billing staff by about
  1/2 FTE.
• Our printing costs are also radically reduced.

26
2003

• Front Office 8.5 FTE for a salary of 171,572.
• Billing Department 3 FTE for a salary of
  126,707
• Transcription 1.5 FTE for a salary of 48,417

27
2005

• Front Office 6.5 FTE 156,360
• Billing Dept. 2.5 FTE 98,171
• Transcription Occasional 500.

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COST REDUCTION

• FRONT OFFICE 15,213
• BILLING DEPT 28,536
• TRANSCRIPTION 47,900
• TOTAL 91,649
• Our front office staffing is now down to 4.75 FTE
  and this has held constant.
• We have added an Internet based Patient portal
  that we hope will continue to support these
  reductions.

29
OTHER BENEFITS

• Direct faxing of referrals from EMR.
• Patient Safety. All scripts checked for drug
  interactions and allergies.
• Quality improvement. HEDIS, DOQIT.
• Reporting capabilities allow for improved
  performance on physician performance programs
  like E-Blue and other similar programs.

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Other Benefits

• When you have a computer in the room with a
  patient you also have immediate at the bedside
  access to other internet resources ie. Epocrates,
  MDConsult, Firtst Consult and a multitude of
  patient education resources that you can access
  and print for the patient.

31
Pharmacy Management

• Many EMRs are adding additional
  Pharmacy/Formulary resources including RxHub
  which can track your patients prescription usage
  including those from other providers. This also
  allows you to to participate in E-Rx incentive
  programs such as the new Medicare incentive.

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