the path to paperless
We Decide To Go Paperless
The practice makes the commitment to adopt EMR.
By Peter J. Polack, M.D., F.A.C.S.

Most medical practices today use an electronic practice management system (EPM). Historically, these were custom products with proprietary software which were a quantum leap beyond pegged ledger books and handwritten appointment calendars. Over the past two decades, the market in EPMs has blossomed into a large industry, replete with numerous products running on many platforms. But even as these systems were being widely adopted, the dream of a "paperless" office still seemed unachievable.

Early attempts at electronic medical records (EMR) systems were modestly successful for subjective-objective-assessment-plan, or SOAP-based, specialties such as family practice and internal medicine, which are primarily text-driven. However, visually intensive and graphically oriented fields like ophthalmology proved to be the bane of EMR developers. Many medical practice consultants still believe that EMR systems for ophthalmology are not quite ready for prime time. In part one of this series, I'll explain why we decided it was time for our practice to make the conversion to EMR.

	ILLUSTRATOR: MARK HEINE/ DEBORAH WOLFE, LTD

More Room or More ROM?

Our practice has been using an EPM system since 1983. Our first EPM vendor informed us they would no longer offer support as of Y2K, and we converted to another system, one of the major players at that time.

However, while this fulfilled our billing and scheduling needs, we came to the realization that we were running out of physical space for storage of our medical records. We were thus confronted with a critical, and potentially expensive, decision: to obtain more office space or move towards the ideal of eliminating paper charts. The cost of modifying additional office space would cost upwards of $50,000 plus annual rental costs of about $20,000. The big question was, of course, would converting to an EMR system be more cost-effective?

Our practice, with five separate offices, uses a centralized medical records storage area located within our main office. This centralized system insures the security of the charts, but carries with it the inherent costs of paper records: staff-hours for pulling charts, copying and faxing records, and costs of transportation. We considered a simple scanning solution that would help to alleviate the storage problem. However, we felt that this was just a stopgap measure that wouldn't help to improve our clinical efficiency and would severely limit access to our old data.

Assessing the Costs of EMR

For our practice, implementation of an EMR system would include the costs of:

• licensing of the software, including training
• ongoing technical support
• hardware such as computers and servers
• infrastructure, from capital expenditures on wiring to ongoing costs for high-speed communications lines between offices
• information technology (IT) staff or consulting.

In addition, we would incur costs involved with staff-hours for training and data entry -- including customization of the new software and conversion of any necessary data from the previous software system. In most cases, a practice will run both the old system and the new system in parallel until such time as data conversion is complete or accounts receivable are caught up. This means duplication of some services such as technical support and "clearing-house" costs for the old system.

Making the Call

We made our decision to adopt EMR, in large part based on the need to stem the ever-burgeoning tide of paper records. We also wanted to deal proactively with the realities imposed by the HIPAA regulations, such as enhanced privacy and security of patient records. At the same time, we felt we could benefit from the numerous advantages of electronic records including:

• enhanced documentation with direct or remote access to digital imaging and special testing
• improved efficiency and better communication, both within our own practice and between our practice and other physicians
• improved coding and compliance
• better integration between the business department and administration.

We calculated that the hard costs of the software system, technical support, infrastructure, and hardware could be recouped over the next 5 years, based primarily on not having to acquire more office space, savings from elimination of clearing-house costs, and reduction in printing costs. Savings from reduced staff-hours (for pulling charts, faxing, and transporting records), job consolidation from redundancy, and improved staff efficiency are more difficult to calculate, but we're planning to keep track of these areas going forward in order to document our progress and more accurately calculate the return on our investment.

Lastly, the writing is on the wall, or tablet PC, if you will: The adoption of an EMR system by every medical practice is inevitable. There's increasing pressure from the government and insurance companies -- in terms of incentives or penalties -- for standardization of documentation, reduction in medical error rates, and documentation of quality to make EMRs obligatory. Competition has pushed down the costs of both software and hardware to the point where even small practices can afford to go paperless. Ultimately, the successful implementation of an EMR system is dependent on the unwavering commitment of the physicians involved in the project.

Next installment: Changing Office Culture

Peter J. Polack, M.D., F.A.C.S., is co-managing partner for Ocala Eye, PA, and a specialist in cornea, external disease and refractive surgery. Founded in 1971, Ocala Eye is a seven-partner, multisubspecialty ophthalmology practice located in Ocala, Fla. The practice, which has five locations including an ASC and laser center, has 120 employees.