March 2006

Transforming Practice Operations and Creating an EMR

A decision four years ago led South Point Family Practice, based in Belmont, N.C., to transform its 8 physician organization into a totally electronic practice.

David Rinehart, MD, said that physicians in the practice reached a boiling point a few years ago when they were fumbling around trying to find patients’ paper charts. A chart could have been at either the practice’s two offices, further compounding the doctors’ frustration.

The practice simply could not find paper charts in a timely manner, nor could it respond efficiently to questions from patients regarding medication refills. “We just had way too much paper-shuffling going on,” Dr. Rinehart said. “We could not get the right paper at the right place and at the right time.” The two primary care offices, receive more than 1,000 calls a day. “The majority required some type of clinical judgment. And to make those judgments, you needed to see the chart or a previous record, Dr Rinehart continued. “With charts all over the office, or at the other office, and having to fax things back and forth, it became too cumbersome, and drove us toward a totally electronic patient record.”

Controlling chaos
Dr. Rinehart also said that keeping track of clinical information on specific patients and keeping their medications straight was also a cumbersome task -- one that was ripe for errors. The practice needed a more efficient way of refilling medication orders. “A lot of patients have five or more medications that need refilling. Some change pharmacies, or change pharmacy benefits manager. It was a huge hassle to makes these changes every time they came up,” he said.

South Point Family Practice selected eClinicalWorks to transform its office procedures and digitize its patient records to help streamline daily tasks and enhance care delivered to patients. The practice wanted a coordinated medical and clinical record system that would solve its many challenges. By implementing technology from Westborough, Mass.-based eClinicalWorks, the practice now has an electronic medical record (EMR) system that streamlines and centralizes its operations, from front- to back-office, giving physicians and physician assistants access to all the patient information they need.

eClinicalWorks’ EMR and integrated practice management system are designed for multi-specialty and multi-location practices. The Mid-Office Management system is a complete EMR for small and large multi-specialty providers, according to the company.

“As a growing practice, we found it increasingly difficult to effectively manage the massive amounts of patient information and requests that came with having a large patient base. HIPAA mandates presented another huge challenge for us,” Dr. Rinehart added.

Since going live, South Point’s operations have been transformed. Stacks of paper charts have been eliminated, and, as a result, the office staff and doctors no longer have to frantically search for a patient’s chart. Instead, the office staff has all necessary access to patient information, which is more accurate, in-depth, reliable and, most important, available. Also, creating a new patient’s chart electronically has been reduced to just a few minutes, saving the practice resources in time and money.

The phone memo pad
At South Point, the office receptionist used a memo pad to hand-write phone messages for physicians. The receptionist also used the memos as a way to communicate with physicians. For example, a notation on a memo sheet would prompt someone to locate a patient’s chart number. After the patient’s paper chart was located, the memo was clipped to the chart. The physician would have to be notified that the memo attached to the chart needed attention. The physician would then look at the request, make a decision and hand it to the nurse, who would either call the pharmacy with the prescription refill order, or contact the patient to discuss further why the medication couldn’t be refilled.

“Jump ahead to our much more efficient process today,” Dr. Rinehart said. “We get a phone call or a fax, and turn that into an electronic record immediately. The electronic message goes into the proper patient’s record, and any required clinical information is located at the same place as the message. I’m now able to fax it myself. This eliminates a number of steps along the way, and is much more accurate. And I can send the prescription before the patient has left the office, so that the pharmacy can immediately begin to fill the prescription.” 
 
Drug interactions
When prescribing a new medication to an existing patient, the eClinicalWorks database includes drug-to-drug interactions verification, a large part of what physicians formerly did manually. “Before we had the drug interactions, the doctors in the practice had to remember about possible interactions or rely on their pharmacist’s database. But now it’s in our database. If we know the patient is on three medications, and we add another one, we will immediately know if there’s a drug interaction with the others that have already been prescribed.

“Instead of getting a call back from the pharmacy in a few hours that there is a potential drug interaction, the physician is notified immediately,” Dr. Rinehart said. “This eliminates errors and the prescription is legible. The pharmacist no longer has to infer or decipher what the physician has written. In 2006, it’s my opinion that there is no excuse for a handwritten prescription.”

Patient benefits
The patient’s takeaway from this electronic experience is a much friendlier and responsive doctor’s office. “We’re much more willing to refill patients’ prescriptions. So often in the past when patients changed their pharmacy, benefits administrator or insurance coverage, we got frustrated. And, if the patient had a lot of medications, we’d sometime have a lengthy delay in being able to rewrite medications,” Dr. Rinehart noted. “The patient now gets a quicker and friendlier response because it’s not a huge issue to have to rewrite a prescription for a new pharmacy.”

Implementation hurdles
Dr. Rinehart said that any implementation process involving new technology can trigger changes for the physician staff.

“It was a large project for us. Possibly a smaller group -- say one or two doctors -- could have done the implementation with a lot less fanfare. But, it’s a huge paradigm shift no matter the size of the practice,” he continued. “It wasn’t a big shift for the billing staff or front-office staff, even though we included a full EMR and billing implementation. The doctors had to make the most adjustments, including how they stored clinical data -- the way to move it from their head and dictate it -- to a totally electronic process.” 

Benefits to physicians
Avoiding frustration has been the biggest benefit for physicians at South Point, Dr. Rinehart said. “The data is always available, and multiple people on staff can view it. We can now manage the data much more effectively. Being able to keep track of patient information, rather than having to remember it in my head is a huge benefit to me and my colleagues, and also the patient,” Dr. Rinehart noted.

Mr. Mitchell is managing editor of ADVANCE for Health Information Executives.