Some physicians consider the decision to become a truly paperless medical office a big challenge. Dr. David Morin at Scituate Pediatrics saw it as an opportunity and necessity in today’s healthcare environment of reduced reimbursements and quality of care initiatives. Morin knows that providing quality medical care starts with being able to locate the patient’s chart.
“We were simply getting too big; there were paper charts all over the place,” says Morin. “At any given time 10 percent of our charts were not in the rack and charts from two days ago were in piles. We had piles of referral letters, piles of labs, piles everywhere. Sometimes it was almost impossible to locate a chart. We had three and a half full time employees dedicated to filing and that does not include the staff that was pulling charts,” adds Morin.
To rectify this situation, Dr. Morin led a search for an EMR product that would conform to how he and the other seven providers at this busy Massachusetts-based pediatric group practice medicine. Morin was looking for an EMR system that was flexible and easy to use yet powerful enough that it contained the necessary features to attain his goal of a paperless office.
“What I found was that people who write software rarely sit in a medical office. Often the children we see have multiple problems such as a sore throat, runny nose, and a cough. In some systems, the logic is so tight that you can get hung up in a two minute algorithm describing the cough when you really wanted to thoroughly document the sore throat,” said Morin.
Dr. Morin claims he quickly learned to appreciate the depth of clinical knowledge at Integrated Healthware. Some other vendors sent a sales representative in that did not understand how a medical group operates. “From the CEO to the practicing providers that they have involved in the company it is clear that Integrated Healthware has a strong clinical focus,” he said.
This clinical focus was self-evident as the group began implementation. Integrated Healthware supplied the group with pediatric templates as part of the Starter Kit. These form templates allowed the group to get started quickly and provided a basis from which to create new forms to meet their specific needs. Morin found the pediatric forms were 98% usable as is.
“We chose a Monday as our start date and by the end of the week all of our providers were “Wanging” their charts,” says Morin. All eight providers at the group have been using the system from the start. “I don’t see how you could run a clinic without everyone using the EMR,” adds Morin.
The group is moving to new office space in a new building that is under construction. The goal is to be entirely paperless in the new space. Toward this goal, Scituate Pediatrics has designated a conversion team that is converting their 10,000 existing paper charts. “We will not have a paper chart rack in the new office,” states Morin emphatically.
To achieve this goal, the team is justifiably proud of the unique custom forms that they created to ease the conversion process. Using the Wang Form Builder utility, the office created a custom form that acts as a data capture screen and ultimately feeds the chart information into the Integrated Healthware EMR database. After they developed the form, the conversion team found that it saved no less than two-thirds of the time it would have taken without the form.
In fact, the physicians at Scituate Pediatrics are saving time in all kinds of ways now that the EMR is in daily use. The group’s providers really like the ability to quickly track child immunizations, see lab results, and print referral letters. “When I am with a patient, I can rapidly prepare a referral letter, print it for the patient and e-mail it to the physician I am referring to. And, before the patients walk out the door, I can provide them with test or medication lists and informational handouts regarding whatever diagnosis and treatment plan I have specified,” says Morin.
Morin says parents often call because of a misplaced school form. This simple request previously required an employee to pull the chart and photocopy the form. “Now, it takes only seconds for me to pull up and print or e-mail the form,” he says.
The system has increased efficiencies so well that Morin discovered that the office is able to see more patients without an increase in staff. In fact, the office now requires only .5 staff members per provider. Staff efficiencies, however, are only part of the equation.
Ultimately Morin sees the EMR providing him the ability to automate outcomes reporting and support disease management. “We have a lot of patients with asthma. Once we are fully converted, I will have the ability to easily look up all asthma patients and follow their progress. This is where the EMR will ultimately affect a physician’s ability to quickly track outcomes for a given patient population,” says Morin.
The EMR is pervasive throughout Scituate Pediatrics. Each exam room is furnished with a personal computer and the physicians routinely access patient charts from home while on call. According to Morin, one child’s grandfather, who was along for the visit, seemed to sum it up at the conclusion of a visit with Morin. “He said to me, I don’t understand why my doctor doesn’t do this.” Dr. Morin couldn’t agree more.
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