Letters

Patient flow and real estate

To the Editor:

I have a question in reference to "Tuning Up Your Patient Schedule" [January 2002, page 41]. Where I see patient flow bogging down is when patients A and B both need lab work or to schedule an outside consultation. We have two exam rooms per provider and one LPN per provider who rooms patients, takes them to the lab, gives immunizations and schedules all appointments. We have applied techniques similar to those mentioned in the article in our clinic, but when a lab takes 45 minutes (because the other six providers with two patients at the top of the hour also need lab work) the schedule falls apart. How do you deal with the backlog and still remain on time?

Anne Whitworth, MD
Duluth, Minn.

Author's response:

Two exam rooms are usually not enough if the doctor plans to see approximately four patients an hour, unless there is a separate area to park the patient for lab work or preliminary vital signs, weight checks, etc. One solution is to have providers start their hours at different times. For example, providers 1 and 2 could start at 8:30 a.m., 3 and 4 could start at 8:45 a.m. and 5 and 6 could start at 9 a.m. Then there would be less of a traffic jam at the top of each hour since the waves would all overlap.

M. Kyu Chung, MD
Camden, N.J.

Thank you

To the Editor:

I want to express my deep appreciation for each issue of Family Practice Management. I recently took a leap of faith and opened a solo practice on Dec. 3, 2001. I experienced compassion fatigue ["Overcoming Compassion Fatigue," April 2000, page 39] and have also experienced health care from the patient's point of view because of my own near death from septic shock. I am drawing on all of my experiences ­ good and
bad ­ and hopefully will have a practice that offers an exemplary level of care, compassion and consideration.

I am going through all of last year's issues of FPM. After I read them (and complete the CME quizzes), I pass them on to my husband (my office manager) and then to my receptionist. Coding information has been my priority. I have gleaned so many valuable pearls for maximizing my revenue. I plan to use the concepts of the Institute for Healthcare Improvement's Idealized Design of Clinical Office Practices ["As Good As It Could Get: Remaking the Medical Practice," May 2000, page 48] in drafting my mission statement. We are using the open-access appointment system ["Same-Day Appointments: Exploding the Access Paradigm," September 2000, page 45]. I know my success will be built on what I learn from FPM and other resources.

Ann D. Thomas, MD
Marietta, Ga.

EMR costs

To the Editor:

As the office administrator for the practice my wife shares with a part-time midlevel provider, I read your article "How Much Will That EMR System Really Cost?" [April 2002, page 57] with considerable shock and dismay. The figures used to exemplify electronic medical records system (EMR) costs are vastly out of line and, for most small family physician practices, unreachable.

I understand that the spreadsheet is a tool physicians, their staff and consultants can use to evaluate their own planned purchases and that the numbers they enter are expected to vary. In that way, the spreadsheet is an excellent and instructive tool.

I do have considerable reservations about using such high costs to illustrate usage of the spreadsheet. Those figures are more likely to deter than encourage physicians to get started with EMR systems. It can be done for much less than the example suggests. In my wife's office, we have a network, a server, eight desktop computers, a laptop computer, a networked laser printer, a networked inkjet printer, a DSL connection, a modem, a scanner and considerably more software functionality (including an EMR system) than itemized in the spreadsheet. We set this up almost two years ago for a total initial cost of $17,000, a first-year annual cost of $950 and second-year cost of $1,100. About one third of these costs were for increasing functionality rather than maintenance or upgrades. Hardware prices, in particular, are lower today.

It's easy to spend the amounts suggested by Mr. Valancy in the article, and when practice management software is added, it's easy to spend much more. But it's not necessary, and for most small practices, it's not sensible.

James S. Waldron
Jacksonville, Fla.