An Oklahoma family physician explains how a high-volume practice uses its EHR system
Family physician Stephen Treadwell, DO, is about efficiency and speed. He has to be, in working a busy rural family practice in south-central Oklahoma where he sees 60 to 80 patients a day. In implementing his electronic health record (EHR) system, the pace is so quick, he had to find a workaround.
The solution? During an encounter he uses Vitera Intergy EHR system for simple visits, and transfers to a paper-based system initially to document more complicated visits such as hypertension, high cholesterol, and diabetes.
It might not be a textbook approach, but it works for his practice style.
“We were able to create some shortcuts in the system for simple visits, but for more complicated ones, it just takes too long to work in the system while also giving patients the personal attention they deserve,” says Treadwell, who practices family medicine at Physicians Clinic of Healdton. “Vitera has been great to work with as we try to limit the time it takes to enter all the necessary information, but we generally have found EHR to be time consuming.”
Treadwell has been a solo practitioner in the rural community for 23 years. His biggest challenge as a family doctor, he says, is spending time with 60 to 80 patients a day, while also aiming to increase the practice’s efficiency and maintain a high level of quality care.
“I become the cardiologist, the pulmonologist, the dermatologist, the orthopedist and the pediatrician,” Treadwell says. “Our EHR system has different sections for different body groups, so when a patient comes in complaining of shortness of breath, but also happens to have a lesion I should take a look at, it’s not easy to go from one section of the system to another.
“I pride myself in paying attention to patients, and that would go away if I’m buried in a computer for too long, filling out fields in the EHR,” he says. “That’s just not right for the patient.”
Benefits, and Headaches
Treadwell is one of 29 participants in the 2-year Medical Economics EHR Best Practices Study, an ongoing project intended to draw out real-world insight for healthcare leaders.
He understands the intended value of EHR, and hopes systems continue to advance so that they improve connectivity and care for both practices and patients.
“There are good ideas and immediate benefits with EHR-one of them is no longer needing to spend time listing patients’ medications,” he says. “Also, electronic prescriptions are beneficial and simple, especially for refills. The ability to just click and send a prescription to a pharmacy, with all the insurance information there, is convenient. It’s also nice to be able to look up a patient’s medical history and past labs whenever we need to.”
Treadwell is one of about 85,000 physicians who use EHR or practice management software from Vitera. The company’s system, Vitera Intergy EHR, is advertised as a complete clinical solution with intuitive workflows and interoperability with many medical devices.
Treadwell collaborated with Vitera trainers for 7 hours during two videoconference sessions, attempting to tailor the system to the Physicians Clinic of Healdton’s processes and preferences. “We went down through each section of the system, talking about what I wanted and didn’t want it to show,” he says.
He likes the system’s clinical flow sheets that provide a view of a patient’s progress and treatment effectiveness, and a drug utilization review feature that gives his staff instant access to drug interaction information. He’s less enthusiastic about Vitera’s orders & tasks section, which enables the practice to create and track mammograms, blood tests, and exams.
“But every physician approaches exams differently, and it has taken a lot of effort to customize the system in a way that speaks to our practice,” he says.
At the end of the two training sessions, Treadwell expressed doubt that he could still see 60 to 80 patients a day and use the system extensively. “I asked then, ‘How many people do you think I can see a day if we go full speed with EHR?’” he recalls. “They told me about 20. I said, ‘Well, what I am supposed to do with the other 40, 50 or 60?’ There still isn’t a good answer to that question. I haven’t changed the number of patients we’re seeing.”
Hoping for the future
Today, before a patient visits Treadwell, a receptionist welcomes him or her and enters demographic and insurance information, as well as a chief complaint. That data is sent to a nurse who brings the patient to an exam room, takes vital signs and determines if the patient needs lab work or X-rays.
Soon after Treadwell arrives and talks with the patient about his or her condition, he determines if the visit is straightforward enough to enter data into Visit Note, Vitera Intergy EHR’s documentation tool, or if he should stick with a paper chart.
Although he’s not using Vitera’s EHR system for all patients, Treadwell says the technology enables his practice to capture data it needs to qualify for incentive programs, including Meaningful Use. Data recorded in the EHR automatically populates Intergy’s reporting software (Practice Analytics) so that practitioners can see real-time progress without re-entering data. The system is also ICD-10 ready.
When the next Vitera Intergy upgrade occurs, Treadwell says he may dig deeper into features the practice isn’t currently using, including the ability to generate automated reminders that can let staff members know when a patient is overdue for treatment or follow-up tests.
He also hopes future versions improve his ability to exchange information electronically with labs, immunization registries, and other providers.
“Most doctors don’t like EHR, and I understand why,” says Treadwell. “Solo practitioners are kind of stuck with them. If they took the penalty for not using them away, I’m not sure how many would turn them on. We’re a long way from getting to a point where they absolutely help a practice, but I think there’s going to be significant improvements. When systems eventually learn to talk with each other more effectively, so we all don’t duplicate services so much, the results could be impressive.”