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Planning Eases Implementation
 A doctor who also serves as the resident technical expert at Bone & Joint Surgeons in Charleston spent a year and a half researching electronic health records before the practice decided to implement one last July.
“It started with the reluctant acceptance that we had to make the move,” said Michael Fidler, M.D., the orthopedic surgeon who championed the EHR acquisition in the face of a presidential mandate and federal pay-forperformance initiatives.
Fidler began by reviewing about a dozen systems in all during the course of a year. He also attended the annual conference on e-health called Towards the Electronic Patient Record, or TEPR. He and Practice Manager Richard Martinez sat in on numerous demonstrations, even traveling to New Jersey and Atlanta to assess some systems. They also checked to see if the systems had received the seal of approval from the Certification Commission for Healthcare Information Technology (CCHIT), a certification program that makes sure products meet the basic requirements of functionality, interoperability and security. After narrowing the field to five EHRs, early last year they selected a system that earned high marks for being well suited to an orthopedics and rheumatology practice, where seven doctors see about 600 patients a week.
Fidler said the vendor they ultimately selected was clear-cut about costs, including software, technical support and training on-site for a couple of weeks while the 30 employees learned how to use the system. Fidler’s assistant, Debbie Clendenin, quickly became the person folks sought out when they had a question.
The two employees who head up billing and collections were the first to begin using the new system, which allows them to code diagnoses and enter charges before the patient leaves the office. Since they no longer have coding duties, they have time to pursue receivables and patient accounts in collections, a good start toward recouping the investment, Fidler said.
When it was time for the clinicians to begin using the EHR, the staff scanned the charts needed for the next day into the system, including notes and hospital and pathology reports.
The system’s benefits soon became apparent.
“I love having no charts,” said Fidler. “And the system makes nice, clean, neat notes with an easy-to-read font. I don’t have to carry a prescription pad in my pocket anymore. Orders for therapy and medical equipment are printed out via pen tablet. Medication prescriptions — currently printed out — will soon be faxed or e-mailed directly to the pharmacist. And the messaging feature is a huge benefit,” he said of the way phone calls are converted to e-mails.
While the practice hasn’t yet faced any major IT troubles, key members of every department gather in the conference room each Friday to help one another find solutions to the small problems that arise.
Fidler said the transition team finds a refreshing synergy in working together to make the most of the new system.
“When all of this is worked out, we will have an ultra modern practice,” he said.
— Reprinted from the Fall 2007 issue of Quality Time.
EHRs Help Practice Track Flu Shots
 At the Hummer Family Practice in Elkins, the new electronic health record system makes it easy to make sure patients receive their annual flu shot.
“The first thing I see in the patient’s chart is the health maintenance screen,” said Dr. Terry Hummer, M.D., who practices alongside her husband and fellow family physician, Dr. Joel Hummer, M.D. “Anything left undone is red.”
The flu and pneumonia shots automatically appear as required preventatives when the template for patients aged 65 to 75 is used, she explained. After the first flu shot, the system turns the screen red if more than a year passes without the patient’s receiving another.
“It certainly helps, particularly with the pneumonia shot because Medicare generally only allows it once. I could run a report telling me all the patients who have not had a pneumonia shot, and we could get them in here,” she said.
While the system reminds the Hummers to give flu shots to patients when they’re in the office, the doctors have also taken several other steps to make sure everyone who needs a flu shot gets one, especially Medicare beneficiaries, who make up about 60 percent of the practice.
A poster in the waiting room encourages patients to “Get the flu shot, not the flu.” And throughout the year, the office staff asks patients if they want to get a flu shot in the fall. Those who do are added to a list, which is prioritized to decide which patients will receive the shot first.
When the first batch of vaccine arrives, a flu clinic will be scheduled on Wednesday afternoon, when the office is usually closed. Staff members will call the folks who are sickest first, so that those with diabetes and other chronic illnesses can get the flu shot early in the season. Then they’ll work their way down the list until everyone has had a flu shot.
“We can do it pretty quickly,” said Terry, of the flu clinics. “In an hour, we can do 50 flu shots.” Up until last August, when the office phased out medical charts in favor of the new electronic system, the receptionist developed a list from scratch each year because she didn’t have access to a computer where she could maintain it from year to year.
Using the new computer equipment, the receptionist developed a list last year of about 100 people who requested the flu shot. The list has grown to 150 this year, and will likely be added to every year.
The Hummers aren’t the only physicians to implement an electronic health record, she said. “There are more and more of us,” said Terry. “There are six of us in town who use EHRs.”
— Reprinted from the Fall 2007 issue of Quality Time. |
