EMRs Help Doctors' Bottom Line

James Welters, MD, is chief medical officer with Northwest Family Physicians, an 18-doctor, 100-staff, single-specialty group with three offices based in suburban Minneapolis. James Saul, MD, is an internist at a private practice in Parma, Ohio. The practice consists of two other internistsâ€"Saul's wife and his father-in-law, both part-timersâ€"and three full-time medical assistants.

6%—Percentage of solo or small group medical practices that have an EMR system.(Modern Healthcare, 2008)

James Welters, MD, is chief medical officer with Northwest Family Physicians, an 18-doctor, 100-staff, single-specialty group with three offices based in suburban Minneapolis. James Saul, MD, is an internist at a private practice in Parma, Ohio. The practice consists of two other internists—Saul’s wife and his father-in-law, both part-timers—and three full-time medical assistants.

Despite their diversity in size and structure, Drs. Welters and Saul share an affinity for the electronic medical records (EMR) their practices transitioned to three-and four-years ago, respectively.

“EMR has been the biggest financial boon our clinic has ever had,” Dr. Welters explains. “We’re still independent and profitable while other clinics are selling out.” Echoes Dr. Saul, “I probably see three or four more patients a day since we started using an EMR.”

Carefully Crafted PlanWhen Dr. Welters speaks before physician groups, the plan to transition his clinic to an EMR system comes across impeccably well organized. The doctor laughs, though, and admits that, “It looks more organized in retrospect than it was in the beginning.”

After doing electronic prescribing for nearly five years, the practice found itself in need of a new practice management system. It was decided that if the clinic was going to invest in a new practice management system, it might as well be one that has an EMR component. The transition began one office at a time. Training was at a premium. Processes were added one at a time. One week all phone calls were done in the EMR, the next week all referrals, and then lab orders. It culminated in a paper-free day, one that Dr. Welters’ staff initially referred to as ‘Hate Dr. Welters Day.’ But that mindset quickly changed.

“We found that the staff tended to pull the doctors along,” explains Dr. Welters, a Brown University School of Medicine graduate. “They would be more revved up to make the transition than the physicians. They very much served as the leaders.”

The cost of the transition was $248,395, or $13,800 per physician—no small drop in the bucket. But the savings—the return on investment—more than made up for the initial cost. According to Dr. Welters, return on investment 2006 revenue came to $768,000, or $42,667 per physician.

“If you split out expenses by site, it was within about six months that each individual site had more than paid for the expenses,” says Dr. Welters. “And the biggest reason for that was transcription reduction. In our Plymouth office, we were spending about $5,000 a month on transcription, and within a matter of six months, it was down to around $500. We increased our quality improvement numbers, and we didn’t lay anybody off.”

Success on a Smaller ScaleCost was definitely a factor when Dr. Saul began looking into an EMR system a little over four years ago. The doctor also wanted an EMR that would seamlessly integrate with his practice management system, MediSoft. He found what he was looking for in an EMR from Houston, Texas-based Spring Medical Systems.

“It was intuitive; the program was easy for me to follow,” Dr. Saul recalls. “And it wasn’t as expensive as some of the other systems I had looked into.” That was because Spring Charts enabled Dr. Saul to purchase a “bare-bones, basic system,” then add features down the road on an a la carte basis, which helped keep his costs under control. “We were able to get a basic system, use it to make sure it was what we wanted, without having a huge up-front investment,” he said. “Then we added to it, building it into the system we wanted it to be.”

Dr. Saul hasn’t broken down the numbers, but estimates that within two years the practice was able to realize a return on investment. Part of the reason it took so long, he explains, is that he was the only one using the EMR for the first year. That changed once his father-in-law noticed some of the benefits.

“In the past when a patient would call and leave a message, it would be taken down on a message note, the chart would be pulled, the message would be stuck on the front of the chart, and it would be sitting on my desk,” says Dr. Saul, a Medical College of Ohio graduate. “By the end of the day, there were 20 messages, and delays in getting back to patients.” Now, the phone message is taken directly into the EMR and sent electronically to Dr. Saul. “I answer messages on the fly between patients. There’s no chart pulling, and the response time in getting back to patients has been cut down enormously.”

Stick With ItBoth physicians acknowledge that there’s a learning curve when it comes to EMR implementation. But the key, they say, is to jump in and not look back.

“There’s going to be a period of time when things are not going to be as efficient as they had been,” Dr. Saul admits. “But after the first two weeks I was more efficient than when I was dictating. The benefits quickly become apparent.”

Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at edwardr@ptd.net.

“Money grows on the tree of persistence.”—Japanese proverb