Adam Siladi: Welcome to a live edition of the eClinicalWorks Podcast here at the 2019 National Conference in Orlando, Florida. I’m Adam Siladi. Thank you so much for joining us today. You know, eClinicalWorks has always been a comprehensive EHR, but with the addition of anytime/anywhere access through the browser, it’s opening up new opportunities for growth and efficiencies. And here to talk with us about that is Ron Boesch, who is executive dean of clinics at Palmer College of Chiropractic. Ron, thank you so much for being here today.

Ron Boesch: Well, Adam, thank you for having me here along with eClinicalWorks. I really appreciate the opportunity.

Siladi: We’re thrilled to have you. Now, Ron, tell us a little bit about Palmer College and what you guys are doing.

Boesch: Alright. Well, at Palmer College, it’s a chiropractic college. We have three campuses — we’re in Florida, California, and Iowa. We encompass four states, 29 clinics, 90 providers. So, we’re a fairly large campus, a large clinic system. But we really needed to look at getting a new EHR. We were running out of two systems. We had a Practice Management system, and we also had a note-taking system. And what we found was there was just inefficiencies the whole way. Doctors were taking care of patients along with the students, they’re writing out all the coding in that onto a superbill travel sheet, and they would send it to the front desk. Then they would have to interpret it, scribe it, and put it in. So, a lot of inefficiencies that way. We wanted to go to one system, we wanted to get to one database, one patient record.

Siladi: And, of course, for that you selected eClinicalWorks. Now, you’ve been live on eClinicalWorks for how long?

Boesch: We’ve been live on eClinicalWorks just under a year. We actually signed with eClinicalWorks in July 2018, and then we got into the database after we got the active directory all up and running in September. And then November 26, about 60 days later, we went live. So, we built all that. We had a team putting that together. We had the business side that was led by Miss Gretchen Robinson. We had the clinical side which I was leading, but Dr. Nate Finkey was very important in that, along with Dr. Heather Bowyer. And we built all our templates, everything, and then we went live, kind of like a Big Bang shotgun, all campuses, all clinics, live one day.

Siladi: And how has it been since then? How has that implementation process since that Go-Live period?

Boesch: Oh, it’s been really smooth. Actually since the first day. You know, whenever you start something new, you sit back and you’re kind of like ‘Oh, let’s hope we don’t have any major glitches.’ Nothing. Just a little bit going on. You get around on the floor, you start talking to the providers, you start talking to the staff, and they’re like ‘Yeah, this is going pretty good. We’re actually, we’re really working here, and it’s nice. I’m able to figure it out. I’m navigating well. We had plenty of training. Life — life is really good.’ And since then we’ve been able to really create some efficiencies, you know. We went to the one database, so now I don’t have to sign out the travel sheet, take it to the front desk, have them go ahead and then they’ve got to enter it. We’re conservatively estimating two minutes, about, saved on every data entry from that standpoint, and we do 178,000 visits a year. You start doing the math on that — now you’re looking at about 6,000 hours saved. So, we were able to take those FTEs and repurpose them, you know, into the billing area, into some of our records area. So, it really worked out well. You know, and then, actually, a few of them, we thought ‘You know, we may not need all these employees.’ So, as attrition comes, as someone decides to leave, you just don’t refill that position and you capture those savings back.

Siladi: You know, I like the way that you say you’re repurposing a lot of those employees to help you with some of those areas in which you’d like to improve. I think you mentioned RCM. I think you mentioned patient-facing roles, as well, to improve that Patient Relationship Management, as well. Now, of course, you know, as we said you’re using the web-based version of eClinicalWorks — or the web-based access, I should say, it’s all the same version — web-based access, and because you have this unique scenario where you’re divided up on all these different — not just cities or towns, but states, even — you’re using that to full advantage, aren’t you?

Boesch: Exactly. It’s, you know, when you’re across the country, I mean literally coast to coast and right in-between. We looked at — case in point today, we’ve got the big storm coming through here in Florida — had that been a hurricane and we had to close our campus in Florida, and close those clinics, I can send all those phone calls up to Davenport or over to California. We have one database, so they can pull up all the doctors’ schedules. We can call and cancel the patients, get them rescheduled, because our main focus is patient safety, employee safety, and student safety. So, they can just focus on doing what is right for them to make sure that they’re safe, and we’ll take care of patients on the administrative end of it. And the same in Iowa. We get snow. You know, every now and again you get a snowstorm there and we have to close. Now Florida, who’s fortunate — doesn’t have the snow — can go ahead and cover us in the same direction.

Siladi: True. It sounds like, unlike previous types of systems, which you may have the same EMR in these locations but essentially they were all operating on their own client-servers, you’d have to make up those updates in each individual area, they weren’t all ever talking to one another, it was a lot more to manage. Now, you’re just doing an update in one place and having it roll out to all of your locations.

Boesch: Exactly. When we update, it’s once. Everybody gets updated, we make a change, it gets updated for everybody in the system. We can set up unified training in that way, so it’s not like, well, we got to change it a little bit because this server is working this way or this server is working that way. And we make sure everything is standardized.

Siladi: Now, as far as the actual usage of the EMR goes, you’ve said that you’ve also implemented some standardization and some templates to help you to collect and report on some of the data that you’re interested in, isn’t that right?

Boesch: Yeah, and that was one of our goals by creating all the templates. And we actually did it all in structured data so that we can really search it and go back into it. We have what’s called the Clinical Integrity Program, which is really an internal auditing. So, we go through all our records to see what’s happening with those patients. So, right off the bat we had an improvement in coding, and that score jumped way above our benchmark, because we’re only entering it once. You know, before you were entering it two or three times, different systems, it didn’t always work out as nice as it should. It wasn’t clean. The other thing that happens is if I really want to look at how many patients did I see last month with a non-complicated tension headache? Well, I can pull all that. I can pull even to the level of what was done to them, what was actually done from the standpoint of a physical exam. You know, was it in the cervical spine, what level were they adjusted at? Were they adjusted on the right or left side? So, I can get down to that granular of detail. It works well for research, but actually it looks well for us to look at it from a quality standpoint. Now I can start seeing, OK, which doctors are seeing this diagnosis, seeing the patient quicker, getting better outcome measures, and then, what are they doing to get there? So then we can start creating some standardized workflows and help educate the other providers who maybe aren’t getting quite as good results. It may just be that provider, for some reason they’ve got the golden touch, or it might be just something that they’re doing just a little different that can help the other providers become better.

Siladi: In either case, it sounds like you’d want to know what that is so you can replicate that process as much as possible. And, of course, the things that you mentioned there — that reporting capability — part of that is driven in fact by the flexibility of the eClinicalWorks system. For anybody who doesn’t know, you can set up any structured data that you’d like in the system, just about, and use that for reporting purposes, as it sounds like you are, Ron.

Boesch: Yes, we did. We had a team that did it, Dr. Heather Bowyer and Dr. Nate Finkey really grasped how to set that up, because of how the questioning is set up. But now that we have it, it’s phenomenal. The other thing we’re looking is now down the road with Scribe, is being able to find a way to put that structured data into voice activation, so it becomes even faster. Doctors, everybody talks about work/life balance. So, with this structured data, with our templates, we’re actually able to do our record-keeping faster. We’re able to track who’s getting it done and in how much time. When are they locking their Note, when are they not locking their Note? The students are involved. They’re getting more time for education with the student, and that’s really a big part of it, taking care of patients and educating our students — those are our two main functions. And the students are really benefiting. We did time studies before we had eClinicalWorks in play, and we found that it was about 45 to about an hour that patient care was happening, and that included check-in, that included time with the student, it included time face-to-face with the doctor, and then checkout. Now we’re finding that time getting shorter, but the doctor time is staying the same or increasing, so now the patient is getting more face time and the students are getting more education time. So, in all, everyone is winning that needs to be winning in the system.

Siladi: It sounds like a win situation all around. Now, time motion studies aside, of course the other things that you mentioned here — using Touch, using those other capabilities to take you practice to the next level, is really why we have Conferences like this, right? We have over 100 sessions here this weekend, we’ve got all sorts of tips and tracks going on, and people you can ask your questions to. So, Ron, what are some of the sessions that you are coming to in the next few days here?

Boesch: Well, I’ve already started doing a number of the telehealth ones. We have a couple of docs that do nutritional counseling, and that is something that really plays well with the telehealth, or doing the video visits. Other things that we are looking at is Occupational Health. We do DOT physicals, looking at that, maybe even starting to get into some of that direct contracting with employers to run their chiropractic portion of their care. They have a lot of patients, and, let’s face it, low back pain is one of the number one costs for employees with work comp. We can help with that quite a bit.

Siladi: Excellent, Ron. Well, I hope you do get a lot out of this weekend. I hope everybody here does, and if for anyone who has not come to the Conference before, make sure you do next year. Of course, you can check out our other eClinicalWorks Podcasts on iTunes, YouTube, and my.eclinicalsworks.com. For the eClinicalWorks Podcast, I’m Adam Siladi, and thanks for watching.