Successful EHR Implementation Stories
It Can Be Done: Seven Successful EHR Implementations
The physicians and staff in these family practices, located throughout the United States, have successfully implemented EHRs. If you're feeling like you'll never get this done in your practice, read their stories. You just might find yourself inspired!
Primary Care of the Treasure Coast
In 2004, Primary Care of the Treasure Coast (PCTC), a ten-physician practice, hired Michael Luton as its new CEO. According to Luton, his experience implementing electronic medical record (EMR) systems was one of the primary reasons he was hired. He set up an aggressive EMR training schedule, and PCTC went live with eClinicalWorks EMR in August 2005.
Dr. Dennis Saver helped Luton spearhead the system's implementation. Having seen demonstrations of EMRs at tradeshows, Saver had been interested in getting a system in place for about ten years but hadn't found the right system or sufficient resources. "I thought, electronic records are the future," said Saver. For Saver, resources that could help the health care team manage their patients' chronic diseases were among the most important features of an EMR system.
"With the [EMR], a query could show me all [of my patients] who have diabetes who are taking a certain medication," Saver said. "That's basically impossible with paper charts. [To me,] that's the most exciting part."
For practices considering buying an EMR system, Saver recommends using resources available from the American Academy of Family Physicians (AAFP) to help map out an implementation plan. According to Saver, knowing the wrong way to decide on a system is as important as learning the right way to make the decision. "Don't just go with the cheapest [system or] the slickest salesman, or blindly [follow] a consultant," Saver said.
Also, expect the process to be time-consuming. "It's a long-haul proposition," said Saver. Selecting an EMR system for PCTC took about 18 months. Before deciding on eClinicalWorks, Saver visited several practices that were using his top two choices to see the systems in action.
Even though an EMR offered the possibility of significantly improving patient care, some of the physicians and staff of PCTC had to be convinced. "Change is hard," Saver said. To get buy-in before implementing an EMR system, he recommended getting physicians and staff involved in the selection process when possible.
For example, initially a few PCTC physicians were nervous about transitioning to electronic records because they lacked the necessary computer skills. To help these reluctant physicians feel more comfortable with the transition to an EMR and to give them an opportunity to express their concerns, Saver and Luton made sure the physicians reviewed the EMRs that were being considered for the practice. Ultimately, said Luton, "[The physicians] who were most reluctant at first, ended up liking [the new EMR] the best."
Pedro Ballester, MD
Before Dr. Pedro Ballester's private practice implemented an electronic medical record (EMR) system, his wife and office coordinator Kathy Ballester was "anti-EMR." "I felt if it wasn't broken, don't fix it," she said. However, in 2004, her husband's three-person staff went electronic using the SOAPware EMR system. After implementation, Kathy described the practice's EMR system as indispensable and said there's no way she'd go back to a paper-based system.
When it came to choosing an EMR system, identifying the practice's specific needs– not only what they wanted the EMR to do, but also what they didn't need it do– was key. The Ballesters' research showed that many EMRs are better suited for the needs of a larger office. They went with SOAPware because its interface and functions worked well for a small office. "I don't do billing in-house, so I knew we didn't need to spend that much money," Kathy Ballester said.
The office maintains a storage room of paper charts containing information collected prior to 2004. Since 2004, all patient information has been stored electronically. Although establishing a network in the office was a big front-end hurdle, Dr. Ballester said that it quickly became clear the EMR made a change for the better. "It improved the documentation," he said. "It was much faster than using paper charts."
In fact, the staff was amazed at how quickly they could find files and retrieve information electronically, and so were vendors and patients who called the office. "I can't tell you how many times [a company] will call and say, ‘I'm calling about Mrs. Ballester's prescription. Could you get her chart?'" said Kathy Ballester. "I [say], ‘I'm ready.' They [say], ‘What?!' And I say, ‘I'm ready! I have an EMR. What prescription are you talking about?'"
Based on their experience, the Ballesters recommend finding a system that works for a practice's specific needs. "[For small offices,] an EMR doesn't have to cost $40,000," Kathy Ballester said. "People are afraid of hidden fees and charges for upgrades. I pay $500 for support per year. That's it."
"The most surprising thing is that it's so easy," Kathy Ballester said. "At the beginning, I wondered, am I going to be able to do this? Now I can't imagine not having an EMR."
South Point Family Practice
When an eight-year-old boy came into South Point Family Practice with symptoms of anaphylactic shock from a bee sting, rapid response was critical. But before the staff could treat the boy, they had to review his medical history, and check allergies and prior treatment. Fortunately, the office is equipped with an eClinicalWorks electronic medical record (EMR) system, so it took just a few seconds to get the information they needed.
Almost four years ago, when South Point Family Practice implemented the EMR, their objective was to deal more efficiently with detailed, time-consuming daily functions such as answering phone calls, managing lab reports and locating charts. However, much of the staff had concerns about the transition from their paper-based system. For example, some physicians and staff were not as comfortable using computers on a regular basis. "That was a very big step," said South Point's Clinical Site Coordinator Robin Whiteside. "[Some physicians] were skeptical, but willing to try."
According to Whiteside, the key to making it through the initial implementation phase and achieving a successful system was having a champion in Dr. David Rinehart, who kept the implementation on track in spite of challenges.
"In the first week of implementation, we had a few people who wanted to throw it out," said Rinehart. "[The new process] was frustrating. There was a lot to learn and some of the people were frustrated by the newness and the inefficiency of getting started. But we persisted."
Whiteside said that Rinehart's implementation strategy made the transition to an electronic system much easier. Rather than switching the entire office overnight, Rinehart oversaw a gradual implementation so that physicians and staff became familiar with one element of the EMR at a time. "We started with the [patient] check-in process," said Whiteside. "We just took a little bit [of the EMR system] at a time until all departments were trained and using eClinicalWorks."
The change was big, but so is the payoff. "We're much, much more organized," said Rinehart. "We are more efficient in managing phone calls, managing lab results [and] keeping track of data."
One of the most noticeable benefits of the practice's EMR system is the ease with which staff members and physicians can locate patient charts. "[When we were using paper charts,] there would be times we'd have three or four chart specialists out hunting for charts. Those people were retrained and are doing different jobs now."
Myrtue Medical Center
Seven months after Myrtue Medical Center implemented an electronic medical record (EMR) system in February 2007, Dr. Don Klitgaard, one of the Center's family physicians, faced a critical situation. A patient who had diabetic ketoacidosis was rushed to the hospital. Klitgaard had seen the patient before, but had not treated her regularly. When the woman was brought into the emergency room, she couldn't communicate, nor was she accompanied by a family member who knew about her condition or what medications she was taking.
It was critical to identify the woman's previous course of treatment and any medications she was taking as quickly as possible. Using Practice Partners, the Center's EMR, the medical team was able to find the information they needed within a matter of minutes.
"We were able to pull up her electronic chart right there in the emergency room and see that she had been in the clinic and they'd made some adjustments in her insulin, and she'd been diagnosed with a urinary tract infection and started on an antibiotic that obviously wasn't covering her infection well," said Klitgaard.
According to Klitgaard, such rapid access to information is a key benefit of making the transition from a paper-based system to an EMR.
Another important benefit is having the tools to manage patients who have chronic disease more effectively. "The thing that's going to change care of patients most is [our ability to better] monitor and track chronic diseases," said Klitgaard. "The [EMR] should be an important tool for that. This is something that in a paper world would have been hard or impossible to do. We're heading down that road." For example, the practice is setting up office-visit templates to help the health care team to collect data that can be used to monitor the progress of patients who have chronic diseases.
For all of the benefits of the EMR, Janelle Nielson, Myrtue's Chief Clinical Officer, acknowledged that the system did require a lot of effort on the front-end and initially slowed things down in the office. "It took some getting used to," said Nielson. However, at this stage of the implementation process, Klitgaard said that the consensus in this rural practice is that switching to an EMR system is a positive change.
For practices considering an EMR system, Klitgaard recommended taking plenty of time to identify what features their office needs, what inefficiencies they're hoping to correct and how they'd like an EMR to accommodate their needs before deciding on a system. "It was surprising the amount of thought required in changing to an [EMR]," Klitgaard said. "The goal shouldn't be to just put your paper system on an electronic system." Although some EMR salespeople may take a one-size-fits-all approach or simply recommend popular features, Klitgaard said that it's important for a practice's EMR selection process to be as specific and individualized as possible.
Greg Hinson, MD
Dr. Greg Hinson started his solo practice in 2001. Frustrated by the amount of time he and his staff spent hunting for paper charts, he decided to look into purchasing an electronic medical record (EMR) system. Hinson started his research online through resources including Physicians' Online (POL) discussion boards and emrupdate.com. "I am a notoriously careful shopper, which is to say I am frugal and obsessive about learning as much as I can as a consumer before a big purchase, "said Hinson. "I demo'ed at least two dozen EMRs."
Ultimately, eClinicalWorks (eCW) emerged as the front-runner because it suited Hinson's needs and promised the ability to expand with features like integrated practice management functions. However, before making his final decision, Hinson wanted to get more user feedback and support, so he started a Yahoo! Group for people using eClinicalWorks. "I mentioned [the Yahoo! Group on] emrupdate.com and on POL," Hinson said. "Before long I had 30 to 40 users of the software logged in and discussing ways to improve their efficiency using the software they had purchased."
Hinson continued to maintain the online group after he purchased the eClinicalWorks EMR. "We still allow EMR shoppers to join and participate in our discussions. We outgrew Yahoo! Groups and are now at eCWusers. [We] have over 5,000 physician members," he said.
The eClinicalWorks EMR has been a success at Hinson's office, despite the initial concerns of some staff members who felt computer-challenged. However, after three days of implementation and training, and a two-day transitional period of light EMR use, the staff was up to speed and felt more confident with the new system. "The staff was won over, I think, the first time there was a phone message and no one had to go looking for the paper chart," said Hinson.
At this point, Hinson's practice is not yet completely paperless. "I would say that we are ‘paper-light,'" said Hinson. "We could be paperless, if everyone else we communicate with [were paperless], but as it is, we were paper-light as soon as we went live [with the EMR system]. Eighty percent of our labs come in electronically; the rest– along with papers from X-rays, consultants, and insurance companies– is scanned in. We do not keep paper charts. They were scanned in [during the implementation stage] and no longer exist."
Hinson looks forward to adapting eClinicalWorks to the needs and demands of his practice in the future. For example, "in the near future I hope to add the eCW Patient Portal, which will allow patients to access parts of their records online, and allow for more secure communication with patients and pharmacies," said Hinson.
Family Practice Partners
When Family Practice Partners, a four-physician office in Tennessee, decided to implement an electronic medical record (EMR) system in 2000, the practice joined the Practice Partner Research Network (PPRNet). This network, overseen by the Department of Family Medicine at the Medical University of South Carolina (MUSC), has developed its own proprietary EMR system.
Family Practice Partners’ staff was receptive to the new system, and the transition to using an EMR was generally smooth. However, said Dr. Susan Andrews, one of the practice’s physicians, “any time you [implement an EMR], you have a lot to do.” Glitches popped up initially, but since 2000, many of those early problems have been addressed. Practices that buy an EMR now should benefit from cleaner, more proven applications, according to Andrews.
Initially, the biggest benefit of going electronic was transcription efficiency. “Transcription is expensive,” said Andrews. “With [the EMR], we save about three times as much as it would cost to send our tapes to a transcription service.” Having an EMR system in place also allowed the practice to bring their billing in-house.
The practice anticipated the EMR’s usefulness, but the increase in productivity that resulted from using the system surpassed the staff’s expectations. All of the PPRNet practices submit reports and are ranked on the basis of approximately 50 quality indicators related to efficiency and quality of care. “At first, we were rated at 55 percent,” said Andrews. “We thought, ‘We can do better than that.’”
By reevaluating and ramping up their use of the EMR, Family Practice Partners was able to improve to a ranking in the top 10 percent of PPRNet practices within one year. In fact, the practice has received PPRNet’s Best Practice Award for the last four years.
Andrews continues to be impressed with the advanced features of PPRNet’s EMR system, such as the ability to provide online house calls around the world, access to a broad range of patient education resources, patient self-monitoring capabilities and a Spanish-English translation feature.
What is Andrews’ advice to physicians who might be hesitant to switch to an EMR? “Number one– do it!” Andrews said. “If used properly, it can end up improving your bottom line and the quality of your practice.”
Cox Family Medicine Residency
Cox Family Medicine Residency is an 8/8/8 program with a rural focus. In 1996, it became the first program in the United States to implement an electronic medical record (EMR) system called Logician (now called Centricity). Because the system was so new, there were many wrinkles for faculty, residents and staff to iron out.
“In 1996 there were a lot of limits to technology that we don’t have today,” said residency faculty member Dorothy Harsen, RNBC, FNP. “Our biggest frustration was with the system being slow. Sometimes we would get hung up for one to two minutes. Today, we get frustrated if there is a five-second delay!”
It was also difficult to trust an electronic system initially, so the program weaned itself from using paper charts gradually. Once the EMR system was in place, the staff put a red dot sticker on each paper chart every time it was pulled. According to Harsen, the goal was to have all of the pertinent historical information entered into the computer by the time a chart was marked with the third red dot.
As the system was fine-tuned and faculty, residents and staff became more computer-savvy, the learning curve improved noticeably. “[At first], we spent all day in training on a test system because it was such a foreign concept to us,” Harsen said. “Now, we orient new residents in three hours on the live system.”
Initially, Cox Family Medicine Residency focused on documenting and storing patient data with their EMR system. However, after a few years, faculty and residents began sorting data on the basis of “observational terms” to generate reports. The program has incorporated decision support tools into its forms. Additionally, said Harsen, “We have access to the Internet from the exam room to be able to look up information from sources such as DynaMed, UpToDate and the [Centers for Disease Control and Prevention] (CDC).”
Among the benefits of the EMR system are the ability to access patient charts from multiple locations, ready access to clinical practice guidelines and electronic prescription refill ordering. Centricity has also proven its value for checking medication interactions. “I don’t know how we survived without this [function],” Harsen said. “The interaction checking is coded red, yellow and green– like a stoplight– for severity of the consequences.”
Cox Family Medicine Residency has also used the EMR system to develop a diabetes registry. A report card that logs essential information about each patient who has diabetes is available to both the care provider and the patient. The improvement in the quality of care has been striking. “Before [we used] provider report cards, it was easy to say, ‘I have my [patients who have diabetes] under good control; [I] make sure they see the eye doctor and monitor their kidney function.’” Harsen said. “But once we could see the numbers in black and white, we realized that sometimes we just thought we were doing that.”
According to Harsen, taking advantage of Centricity’s many features has made a huge impact on Cox Family Medicine Residency’s effectiveness. “The [EMR] has completely changed our culture,” she said.