Involvement Is Key to Success With EMR

March 1, 2011
Ed Rabinowitz

Physicians are finding that whether they take a phased-in approach, or dive right in to implementing an electronic medical records (EMR) systems in their practices, the key to success is for doctors and nurses to be involved in the process from the start.

Jonathan Bertman, MD, decided several years ago that he wanted his Hope Valley, R.I.-based South County Family Medicine practice to go paperless. However, after researching dozens of electronic medical records (EMR) products, he found that most either didn’t address his needs or were too expensive for his small practice. So, he built his own system called Amazing Charts.

When the Worcester, Mass.-based Fallon Clinic began implementing EMRs in 2001, Lawrence Garber, MD, medical director for informatics at the clinic, found that 60% of physician notes were still being dictated and typed by transcriptionists. The clinic began phasing in Dragon Medical speech recognition across its 20 locations in 2008 and ended up saving more than $7,000 per physician annually in transcription costs.

What’s the common denominator in these two success stories? “You really need to have clinicians involved with [EMR] implementation,” Garber says. “It’s a medical tool, and has to be implemented as a medical tool by physicians and nurses who understand medicine.”

If You Build It…

When Bertman was looking for an EMR, his main objective was to find one that would “let me do what I have to do in the office more efficiently than I can with paper.” However, he was shocked to find that it took him longer to document his notes using virtually every EMR he researched than it did with paper files. Bertman was told by EMR vendors that he would first have to learn how to use the programs, and should even plan on reducing the practice’s schedule so that he and his staff could learn.

“That’s ludicrous,” Bertman says. “Physicians know how to document notes. We’ve been doing it since medical school. And alarmingly, even to this day, these programs are not designed for rapid documentation.”

So, Bertman, who is also founder and CEO of Amazing Charts, built his own EMR. Today, more than 3,500 physicians in solo, small- and medium-sized practices are using the system.

“Most EMR companies don’t provide a free trial for physicians to use [the EMR] in their practice, or a risk-free, complete money back guarantee,” Bertman explains. “Physicians should make vendors put their money where their mouth is. If they can’t use this free and try it out and make sure it works for them, then I wouldn’t even look at that EMR.” He also suggests that physicians start by documenting notes in their EMR and make certain it works before diving into the much larger billing side of things.

“Take it slow, there’s no rush,” he says. “Look at studies, talk to colleagues who use the programs you’re thinking about, and then make sure you’re not signed into a long-term deal.”

Addressing Physician Needs

Garber, of the Fallon Clinic, recalls that even after the initial EMR implementation, physician reliance on transcriptionists meant the clinic was still incurring expenses up to $10,000 per physician annually. “That was our budgeted savings to pay for the electronic medical record,” he says. A phased-in approach to integrating Dragon Medical speech recognition across the clinic’s 20 locations changed all that.

“The reality is that practices are busy,” Garber says. “Patients continue to get sick. It’s not like you can tell patients, ‘We’re going to be implementing electronic medical records over the next few months, so don’t call us. Call us back in a few months when we’re all done.’ You can’t do that.”

Garber compares the phased-in approach to trying to change the engine on an airplane while it’s in mid-flight. The clinic chunked the implementation into phases, with each phase taking only a small toll on productivity.

“You want to get the largest chunk of change without causing the plane to crash. And then you wait, you let the plane come back up to altitude, and then you hit it with some more change,” he says. “Again it loses altitude, and you wait for it to come back up. And by doing it in that phased approach, we were able to roll this out in a way where nobody quit, no patients were harmed, and actually physicians felt very comfortable with the process.” Turnaround time for the final note going into the EMR system dropped from 3.8 days to 46 minutes.

Making the Transition for Good

When Amy Whittington, NMD, implemented an EMR into her Peoria and Scottsdale, Az.-based practice, the key to a positive outcome came when she decided to just jump in.

“I kind of tried to do it in a step-wise manner where the charts were scanned in but I still wasn’t sure if I was going to be comfortable in the room with the electronic charting, so I was somewhere stuck in the middle of paper charting and electronic charting,” Whittington recalls. “At some point I kind of questioned whether or not I was causing myself more work. And so the moment that I made the transition for good and said okay, my paper charts are no longer, it became so much easier. It certainly allowed my practice to grow because of less paper shuffle.”