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A look at how an electronic health records (EHR) system made e-prescribing, charting, and reading a doctor’s handwriting easier for a family practice in Columbus, Ohio.
At a time when healthcare providers seem to be dwelling on the idea of collecting-more patients, more billings, more cost savings, and more meaningful use incentives-Kevin Olson, DO, and his practice, Columbus Health Professionals in Columbus, Ohio, is focused instead on connecting.
Olson, a family practitioner, is charged with suppressing costs with improved efficiency, and impressing patients with improved care. Like many of his peers, he realizes that today’s healthcare system is under the gun and under the microscope, and that is why he’s sticking with an approach that has worked for 25 years.
“I see kids from the womb to the tomb - little tykes, adolescents, middle-aged folks, and geriatrics,” he says. “More than anything, we value our relationships with those people and always want to provide optimal care, no matter what they need.” Columbus Health Professionals offers a wide range of services, including orthopedics; ear, nose, and throat care; obstetrics; and wellness checkups. The practice has about 10,000 active charts, Olson says, and he sees from 30 to 60 patients a day.
The self-effacing Olson is a self-proclaimed “man of the Stone Age,” but last winter he wondered if Columbus Health Professionals could benefit from punching more keystrokes and using less paper. He wanted to know how he could speed up medical charting, receive lab test results faster, and begin to prescribe medications electronically.
Olson certainly isn’t alone. When healthcare consumer demands grow and internal resources seem to be stretched thin, even many old-school physicians are considering new ways to achieve optimal results. To that end, Columbus Health Professionals became one of 29 participants in the 2-year Medical Economics Electronic Health Records (EHRs) Best Practices Study, an ongoing project intended to draw out valuable, real-world insight for healthcare leaders.
The study paired Olson and other physicians with nine EHR vendors. He and his staff used Practice Fusion, a free, customizable, cloud-based service founded in 2005 that now has more than 150,000 users. The software platform is comprehensive-it includes charting, scheduling, billing, e-prescribing, lab integrations, and secure messaging-and it is geared mostly to small practices that can get started with EHRs using just a computer and an Internet connection.
“I had heard and read about electronic medical record war stories,” Olson says, knowing that the transition and training might be painful. But he also envisioned potential long-term benefits including improved efficiency, information management, and patient education and care. “Just having immediate access to each patient’s information,” including his or her panel, health status, prescription history and other data, “can help any practice,” he says.
Olson wanted Practice Fusion to enable his team to access real-time information needed to make data-driven decisions. He wanted to improve operational efficiency, yet maintain patient volume. He wanted his staff to quit mentioning his hard-to-read handwriting and instead read prescription information clearly on a computer. And he wanted to still make it home by 5:30 p.m.
Preparation, training, and early reaction
While many organizations view charting, scheduling, and billing as integral, Olson and his team believe those procedures are integrated-part of a single system that can help the practice centralize its information.
As part of his evaluation, Olson wanted a vendor with low upfront costs, a growing base of users, and features that would fit the workflow of his practice. “We chose Practice Fusion because it looked like a reasonable program at a reasonable cost,” he says. “But we were cautious from the get-go. I talked to some peers, and most have tried two or three systems before settling on one that worked best for them. So I wanted ours to be affordable, in case we needed to change, and to look like something that would fit our practice.”
Emily Peters, vice president of marketing communications for Practice Fusion, says the price point is a big plus with doctors. The support from advertising allows for the system to be free. “We hope everything else makes them stay with us,” she says.
It only takes seconds to sign up for an account, but “it doesn’t take seconds to learn,” says Tina Huther, office manager at Columbus Health Professionals. She and several other staff members spent weeks learning the new electronic means of data capture and rethinking multiple processes in the practice, including patient data entry, coding, and prescribing.
“I don’t think anyone here began as a big fan of EHRs,” Olson says. “I was pretty much computer-illiterate, so for me, it was a real pain. I could see the information was going to be there at my fingertips, but our learning curve has been slow. One reality is that people learn in different ways, and even if the system is supposed to be intuitive, not everyone is going to learn at the same pace, or in the same way.”
Huther says she is a visual learner, and would have preferred in-person training, instead of an online support system, even with unlimited access. “The first day, I would have thrown it away if I could have. I mean, I could tell it definitely had possibilities for improving the practice, but the early frustration level was through the roof,” Huther says.
Olson says he and his staff are now learning more about the system’s customizable forms and templates. “One thing we learned early on is that it’s important for what I write down to enter the system in the way I had intended,” Olson says. “That can be a challenge, because computers do what they’re told, not necessarily what we want them to do.”
Improved medical charting and e-prescribing
Designed by doctors and medical associations, the system boasts more than 220 medical-chart templates designed to serve the needs of dozens of specialties, Peters says. Although Columbus Health Professionals hasn’t delved deeply into the system’s customizable features, “we’re getting value from the charting module,” Huther says. “It’s compatible with our processes, and we like that we can edit them. We think we’ll get quicker with time.”
Convenience has been the biggest advantage of online medical charts, Huther says. She and others at the practice can see an instant list of diagnoses, prescriptions, drug allergies, and past medical history. From one dashboard, they can manage medication lists, immunization records, and Centers for Disease Control and Prevention growth charts. Also, referrals are accessible directly from the charting workflow, so Olson could send a patient referral as he is finishing a chart note.
Aside from medical charting, e-prescribing is where the practice is reporting EHR success. “A few years ago, there might have been five medications for common conditions. Now, there might be 50, and that complexity isn’t easy to handle,” Huther says. Once Columbus Health Professionals’ credentials were verified, the practice could begin e-prescribing to more than 70,000 U.S. pharmacies through its EHR account with just a few clicks. The practice is also integrated to labs such as Quest, LabCorp, and BioReference, as well as some regional facilities.
“The absolute biggest pro for our office is that we can read Dr. Olson’s handwriting, because there isn’t any to read. We won’t have a problem with transcribing prescriptions incorrectly, which happened from time to time in the paper-based system,” Huther says. “Also, the fact that doctors can share information with one another right away is a huge benefit.”
Huther also looks forward to using the EHR for scheduling, and integrating laboratory and imaging results. “We know we’re not taking advantage of everything the system has to offer, but charting and e-prescribing have given us a start,” she says.
Results and expectations
Before adopting the EHR, Olson would write down medication lists for older patients. Invariably, some of those paper sheets would literally get lost (patients would misplace them) or metaphorically lost (in translation when patients struggled to decipher the handwriting). “That part of patient care is better already because of the electronic system-my ability to educate the patient with these medical records has improved, and hopefully will keep improving,” he says.
Despite the practice’s struggles, Olson says, he believes in the carrot that some medical technology proponents hold as cardinal truth-that implementing an EHR system will negatively affect productivity at first, but the increased access to data
ultimately will improve patient engagement and billing.
“In general, I now believe EHRs mostly help with volume,” Olson says. “If you’re used to spending 45 minutes with one patient, as some specialists admirably do, then EHRs probably won’t change any productivity. But if you’re structured like us, and you might see 60 patients a day, and you’re switching from paper to digital, then in time you’ll probably see your volume rise without too many problems.”
For meaningful use attestation, Columbus Health Professionals has access to a dashboard that updates daily and tracks goals. According to Peters, Practice Fusion has helped users receive more than $100 million through meaningful use 1 and 2 stimulus incentives.
When it comes to metrics, Olson says the practice is less concerned about tangible benefits and more concerned about continuing to foster a positive connection with patients. “I do look forward to a time when more physicians will be able to share medical information easily and securely,” he says. “We’re learning more about what we can do with the system. It started out painful, but I like the potential.”
Medical Economics EHR Best Practices Study