Georgia Physician Magazine

Going Paperless

Implementing an EMR system into your practice with confidence

When North Fulton Family Medicine's Drs. Tom Bat and Jim Morrow decided to implement an electronic medical records (EMR) system into their practice in 1998, it was mainly to reduce transcription costs. Then, the practice consisted of four doctors in two locations. What they found, however, was a marked increase in the quality of healthcare his practice was able to deliver to patients. Prescriptions were legible, so errors occurring from misread handwriting were eliminated. The system also automatically flags potential drug interactions and potential patient allergies to medications.

So if an EMR system can save time and money while improving patient care, why doesn't every practice in Georgia use one? When North Fulton Family Medicine purchased the system seven years ago, 3 percent of physicians were thought to be using some type of EMR system. Today that percentage has only increased to 14. The two factors physicians fear most are extremely high cost and an overwhelming inconvenience of implementation, myths that Morrow says should be dispelled.

"EMR systems are much more affordable than people once thought," he says. "The main resistance has been to cost, so doctors should educate themselves first. As a doctor, you have to be a trailblazer."

Bat and Morrow researched EMRs and educated themselves on the different types of systems available by attending trade shows and watching demos of what the systems could offer. North Fulton Family Medicine uses the HealthMatics EMR system by Cary, N.C.-based A4 Health Systems (at the time, the software system was owned by and purchased from Glaxo, but was later sold), which paid for itself in less than two years. For an approximate cost of $180,000, North Fulton Family Medicine, which today consists of eight doctors and eight physician's assistants in three locations, saves around $300,000 per year in transcriptions costs alone. In addition, an estimated $250,000 is saved from doing away with chart generating, chart pulling and filing, and the materials cost of building a patient chart.

There also is an issue of security. Rather than remaining HIPAA compliant by using a paper shredder, a password protects the patient's privacy. Charts aren't available to be riffled through, and viewers of patient information in an EMR system can be tracked.

Making the switch
The transition from a paper system to an EMR isn't the enormous undertaking many physicians assume it to be. Paper records are scanned into the electronic system, and only recent information is actually needed. Just as a paper chart is thinned, leaving only the current or important information and storing the rest, the electronic record does not have to include a lifetime of patient history. Pre-existing paper records that are too old to be relevant can still be stored, just as they would be anyway.

The goal is to automate the records seamlessly," says Dr. John Dulcey, chief medical officer for Horsham, Pa.-headquartered NextGen, a company that makes EMR systems. "The key is in the preparation for going 'live.' The system is tested and ready with a process in place. The users are trained, and a 'train the trainer' approach is used (a staff member becomes a 'super user' and is trained to help others)."

Typically, after a contract is signed, the implementation process is outlined for the staff. Different staff members might be assigned different roles in the transition process. Next, an inventory is taken of what hardward, wiring, etc., already exists at the practice. The staff will see a demonstration of the product and will receive training either on-site or, for larger staffs, in a two-day, off-site customization class. The system is installed and the process begins.

"The entering of patient information for existing patients usually starts about three to six weeks out," says Crystal Upson, client relations manager for A4 Health Systems. Upson also reiterates that the ultimate goal for buying an EMR system should be to cut down or eliminate the most time-consuming and taxing record-keeping functions of the practice.

"The evolution is worth the time and effort," says Upson. "And choosing a system customized for a practice is important enough to get educated and view demos. Often, people are afraid of the unknown. Viewing a demo can help physicians to see that the system is easy to work with."

Dulcey says additional benefits of an EMR system include ability to access charts from a remote location, such as an emergency room, hospital or a patient's own home or office. Cost is continuing to decrease each year, and more financing methods are becoming available. In addition to flagging drug interactions, Dulcey says the system can perform a database search when, for instance, a drug recall is issued and letters to patients need to be generated. This saves hours of administrative time.

Bedside manner
Morrow says overall, patient acceptance of EMR systems in physician practices has been positive. Many patients are computer savvy and enjoy the convenience of reading lab test results on a secure Web page, rather than driving to their physicians' offices to hear the results. Another huge benefit for patients is online prescription refilling. Still, physicians have to keep the patient connection alive.

"The face time can be increased because time is freed up due to less paperwork," says Morrow. "But the physician has to be sure to pay attention to the patient, not the computer. Patients should always be called in for the delivery of serious lab test results as well."

A yearly maintenance fee covers minor and major updates are made to the system each year.

"No physician will regret implementing an EMR system," says Morrow. And he should know. He works with a practice that is not looking back. And the paper shredder? It's in the storage closet.