Two years after installing EMR, a practice delivers its status report.
By Michael Harris, M.D.
Two years ago, our seven-physician,
five-office retina practice in northern New Jersey began using
electronic medical records (EMR). We marked the anniversary this year by
evaluating whether we had achieved our goals and where we would go from
here.
The short answer is that we have achieved some of our goals, but not all
of them. We have gotten value out of the system � both in dollars and in
quality-of-life improvement. Moreover, the opportunities afforded us by
the switch to EMR continue to expand as we move forward. There are areas
of our work where we can gain still more value � by automating more of
our clerical work and by taking advantage of better access to
information.
Our journey began 4 years ago when I approached my partners with the
idea of switching from paper charts to EMR. With some trepidation, we
agreed to investigate the possibility. Our concerns were many, but the
big question was �Why bother?�
Why Bother?
Our initial thoughts were, �We have a successful practice that has taken
many years and hard work to build. What benefits are possible from a
change to EMR that would be worth the inevitable disruption?� In
retrospect, it is clear that this was the right question to ask. There
are two areas where we hoped for major benefits from our EMR system;
information retrieval capability and improved profits through a
reduction in expenses and increased revenue.
Information retrieval.
As a multi-office practice with many patients
calling after hours with emergencies, we were plagued by the lack of
accessibility to patient records. If we could access a patient�s records
from our home computers, we could provide better patient care when
called at night or on a weekend. We would often examine a patient after
hours or on a weekend and the chart would not be available. Even when
charts were available, images such as luorescein angiograms were not
accessible from every exam room.
Improved profits.
Like any other investment choice you make for your
practice, investing in an EMR should be evaluated against the return on
your investment (ROI). Good, hard financial thinking should guide your
choice � not some general sense that EMR will help your practice. We
analyzed all the areas where we thought the new software might help us
and put hard numbers next to each one. Price is not the most important
criteria � rather, think ROI.
One important factor often not considered in the ROI equation is
physician time. How much time does it take to peruse a paper chart and
determine the pertinent past history and the reason that the patient is
here for a visit? Then, after the exam, how much time does it take to
document the visit and dictate a letter to the referring physician? With
the electronic record, is the speed of the patient encounter faster or
slower? If the EMR slows the doctor in the exam room, it is too
expensive at any price.
Do Your Homework
All the questions in the above box should be asked and answered before
you choose to go ahead with implementing new software. These ideas
should be foremost in your mind when choosing a vendor. We were
concerned about the failures we had heard about when other practices
tried to implement EMR systems. We also asked prospective vendors to
talk to us about their implementation failures as well as their
successes. As a result of these conversations, we developed a set of
criteria and opinions about avoiding the worst possible outcomes.
Following are three recommendations to help ensure that you make the
right decision before committing to EMR:
Make sure that your practice is truly committed to
positive change. Electronic software is a powerful tool for transforming
your practice. Think �chainsaw� � really efficient for clearing out
unwanted trees in your backyard, but must be used with care and
commitment if you do not want to wreck the place.
Understand that all software is not the same. Ask your vendor to tell
you what percentage of their installs fail. Ask why they fail. It is
just as important to understand why practices fail with a particular
software program as why they succeed. After you understand the failures,
evaluate your chances of success with the different software products
you are considering. Be brutally honest with yourself.
See the software in action. Determine if it would improve your
workflow as compared to your present paper system.
Choosing a Vendor
I believe that one of the reasons our practice was successful in
integrating EMR is that we selected, in IO Practiceware, a product and a
vendor that matched our goals, expectations and level of commitment.
Different software products and levels of commitment are appropriate for
different practices. You must define your goals then select the product
that you believe is most likely to be the right tool to achieve them.
Next, define your vendor requirements in helping you to achieve those
goals. Then select the vendor that matches those requirements.
Remember to ask the hard questions of your potential vendor. Make sure
you are working with a company that will give you the support you feel
you are going to need. Make sure you understand the proposal. Clarify
what is included and what is not � interfaces to test equipment?
Customization? Custom reports? Make sure you are comparing �apples to
apples.�
Our Report Card
We have made the change from paper to electronic successfully, and it
has been no small achievement. Our practice has goals for the future
that have not yet been fulfilled. While we are certainly �in the black�
on the project, we are not putting as much money on the bottom line as
we had hoped. However, we are confident that we will realize the revenue
increases and expense reductions that we had planned � it is just going
to take longer than we had hoped.
The best part of our adoption of EMR is that it is of even more value
than we previously realized. As we move ahead, and as software companies
continue to innovate, we see more places to save money. The categories
that seem
to offer the greatest value to us are enhancements to automatic billing
logic and integration with surgery centers and hospitals.
If you choose wisely, EMR will put money in your pocket and help you
sleep better at night. Commitment to the process � both on your part and
the vendor�s part � is of the utmost importance. Before purchasing
software, make sure your practice is fully committed to EMR. Remember
that this software will revolutionize your
practice.
Further, insure that your vendor is fully committed to ophthalmology and
willing to customize the software in response to your needs. These
issues are critical to your successful implementation of EMR. We are
happy with the decision we made 2 years ago to implement EMR and
anticipate that future software evolution will continue to improve our
results. OM
Michael Harris, M.D., practices at Retina Associates of New Jersey; a
practice with five offices located throughout northern New Jersey. Dr.
Harris serves as a medical director for
IO Practiceware. Information on IO Practiceware can be obtained at (212)
844-0105 or visit their Web site at
www.iopracticeware.com.
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