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Cardiologist says EHR needs more custom features


A Georgia specialist finds it hard to jot life details about patients on stagnant EHR fields

When visiting Doris E. Tummillo, MD, many patients bring their great-grandchildren. She seems to recall their names on first glance, and often asks questions that make everyone in the room feel comfortable: “How is Margaret feeling these days? Are you still walking a few miles a week?”

For Tummillo, a cardiologist in Augusta, Georgia, those questions were easier to ask when she could quickly flip through a patient’s paper chart and read her hand-written notes. “In addition to reading my little scribbles and looking at patient photos on charts, I would clue myself in to a lot of information from recorded notes-about the severity of a patient’s condition, about recent family tragedies and so on,” she says.

She can still add that kind of information using an open comments field in her practice’s electronic health records (EHR) system, she says, but “the biggest issue I’m having with these electronic records is the notion that each one looks and feels the same for all patients-it’s really no fault of the software, but there’s a sameness to EHR that I don’t like.”

Patients have appreciated Tummillo’s desire to connect with them since she began her cardiology practice more than 20 years ago. She sees between 20 to 25 patients a day, a number that hasn’t changed since the spring of 2012, when her practice adopted ABELMed EHR from ABEL Medical Software Inc. Tummillo is one of 29 participants in the 2-year Medical Economics EHR Best Practices Study, an ongoing project intended to draw out valuable, real-world insight for healthcare leaders.

“Overall, it has actually been pretty good, although none of us wanted to make the transition at first,” she says. “It’s nice to pull up medical histories and other details quickly, without having to flip though a chart. We were able to start using the software within a few hours of training, and the ABEL support people have been extremely helpful when questions arise.”


The Value of Customization
The big question for Tummillo when her practice began using ABELMed EHR was: “Will this make us more efficient?”
“So far it hasn’t,” she says, “but I’m hoping it will eventually.”

The “old” technology of paper records might seem antiquated, but it’s flexible, she says, and therefore allows variations in workflow, procedures, training, and other conveniences that software can’t manage.

“I have to see patients in the room and then work in the system later-I can’t do both at the same time, and I don’t want to hire a scribe,” Tummillo says. “That said, it’s easier to access records and see data, and it’s faster to get all information like lab results and medication details in one place.”

Tummillo believes one key to improved efficiency might be further use of the system’s specialty templates. “We all have our own special ways of doing things on a chart. I want to replicate them as much as possible so the electronic form isn’t as generic,” she says.

Essentially, Tummillo aims to remove and organize a multitude of fields and prompts to help her navigate interaction with patients and data input during an exam. She wants to be able to pick diagnostic codes faster, or orders associated with those codes.

ABELMed EHR enables users to create and customize a range of clinical documentation templates, including ones for office encounter notes, progress notes, procedures, and immunizations. The clinical findings Tummillo uses to create one template can be saved as building blocks for other templates to reduce duplication of efforts and  save time, according to ABEL Medical Software Inc. The company ships the software to new clients with a database of more than 20 templates to start, and new ones can be added regularly or by request.

Today, when a new patient enters the practice, he or she registers at the front desk. Contact and insurance information are  entered into ABELMed EHR, and once in an exam room, a nurse adds other details such as medications, allergies, and chief-complaint notes. “When I see that patient, the flow is still the same as it was before EHR, but the way information is recorded is so different,” Tummillo says.

After the visit, she might view the patient’s cumulative profile (essentially a snapshot of overall health), then click on “Encounters” to update information about his or her coronary disease. A staff member may later click on “Referrals and Consultations” to generate referral letters quickly from existing notes, “Patient Education” to prepare instructions and other materials for the patient to take when leaving the office, and “Billing” to automatically create bills using CPT-4 and ICD-9 codes.

“There are a lot of features and capabilities we can use,” Tummillo says. “We need to get more comfortable with them, and that will take more time.”


The importance of training
It's typical for practice workflows to slow by as much as 50% during an EHR implementation, experts say. Entering all the necessary information can be extremely time-consuming.

When undergoing EHR implementation, Tummillo says, it’s critical to take advantage of the vendor’s training opportunities and educational resources. “For us, this has been an excellent experience. It’s not easy to be adequately trained, and ABEL goes out of the way to get us information we need, when we need it.”

One area that consistently leads to successful EHR implementations is the creation and use of EHR “super users” to help train other staff and physicians-something Tummillo says she regrets not doing before her practice began using ABELMed EHR. “Having someone on staff who could train other people here anytime-that would be so much better.”

She says ABEL provides free, easy-to-follow online sessions that are based on client feedback and questions. The vendor also offers nearly 100 on-demand webinars covering topics such as security (for example, assigning a role to a member), front desk reception tasks (color-coding appointments), clinical staff tips (adjusting the view of the dashboard), e-prescribing features (sending prescriptions electronically) and more. Tummillo and her staff recently needed help managing error messages received from pharmacies, and received helpful information from ABEL quickly, she says.

As she and her staff continue to learn more about the EHR system, Tummillo says, the practice will be better positioned to attest for Meaningful Use. ABELMed EHR makes it easier for the practice to achieve those incentives because it provides easier clinical documentation, faster report generation and more accurate monitoring of core meaningful use measures such as clinical quality, Tummillo says.

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