HIGH-TECH PHONES

Saving way more than a buck or two

Here's how one practice integrated the phone system with its Web site and EMR for significant gains in productivity and patient satisfaction.

By Dorothy L. Pennachio
Senior Editor

Patients eager for lab results can help themselves at North Fulton Family Medicine in Alpharetta, GA. They simply call a dedicated number, enter their assigned PIN, and voila, they get the information they're looking for.

"It's easier on patients, and it saves staff time," says Doug Ammon, chief administrator of the seven-physician practice. Patients can call at any hour and don't have to wait for a nurse to riffle through the charts. And that nurse doesn't have to spend unnecessary time on the phone.

Located in suburban Atlanta, the practice has a high proportion of computer-savvy patients. "Lots of them are employed in high-tech jobs," says Ammon. "Not only do they find the system easy to use, but they're impressed that we're on the cutting edge."

North Fulton's high-tech image is burnished when callers are referred to the practice's Web site ( www.nffm.md ) to get directions to the offices and learn how to request routine refills. More computer-literate patients can also schedule appointments.

There's also a computer next to every phone at North Fulton. When a patient calls for any reason, the nurse answering the phone can log into the electronic medical record immediately. Each exam room has Internet access, as well. When a patient asks about a drug she saw on a Web site, the doctor can go to the site, review it, and discuss the drug with the patient. The computers are locked down when a patient is alone in the room.

What about elderly or less techno-savvy patients? If they call the dedicated number for lab results, "they can always hit '0' and be connected to the nurses' station," says Ammon. "We give patients a printed handout before they leave the office explaining the system. Most understand how it works."

Patients hear lab results in their doctor's own voice

The practice uses Televox's LabCalls software for access to lab results and A⁴ Health Systems' HealthMatics electronic medical record system.

"Test results pop out of the lab's computer and go directly to our server and onto our patients' EMR," says Ammon. The doctor is then notified at his workstation that there are lab results he hasn't yet seen and where to find them. He pulls up the EMR and reviews the reports.

"When the doctor signs on to the EMR, there's a tickler on his screen that indicates if there's a lab result with a problem," says Ammon. "Then, on the record itself, abnormal scores appear in red."

To make the reports accessible to patients who'll probably be calling in for them, the physician has two options. Most often, he'll click on a message he recorded previously which says that results are normal. If a report is abnormal or otherwise worrisome, the doctor will record a new message giving the patient instructions, such as to come back in two days, or to increase meds. But if something is significant, the doctor will call the patient to come in for a follow-up visit rather than wait for him to call in.

"A nurse practitioner goes into each doctor's work station on a regular basis. If she sees that a doctor hasn't reviewed lab results, she notifies him," says Ammon.

Patients can call the office for results up to 10 working days after their test. After entering a PIN and hearing their results, patients can then press a key to repeat the message, or another key to leave a message for the doctor. The software automatically generates a report confirming that the patient retrieved the results.

The system issues a daily report listing all messages that have been reviewed by patients. For those not heard, it prints out the patients' names and phone numbers. The nurse calls these patients and reports the lab results the old-fashioned way, says Ammon.

Has a patient ever accessed another person's lab results in error? "It's never happened," he says. He adds that North Fulton has a couple of patients with the same name, but safeguards prevent one patient's results from being put into the other's EMR. When a report comes from the lab, the information has to go through a series of computer-generated passcodes to identify the right patient. "If a patient ever did access someone else's lab results, it would almost certainly be because of human error, not because of the computer," says Ammon.

The system is popular with patients—and doctors

"Most patients like the automated system," says Ammon. "They appreciate being able to access our office any time of day or night to find out their lab results, to make appointments, and to get referrals. They appreciate not having to wait for the nurse to get their chart. And they like hearing their own doctor's voice reading the lab results," he adds. "It helps with compliance."

Still, some patients call the practice anyway, even when their labs are normal, to ask what "normal" means. "Or they'll ask us to mail a printed copy of their results. We try to avoid that because the printing and postage get expensive," says Ammon.

How do the physicians like all this technology in the practice? Are there gripes?

"A couple of doctors are not exactly techies, but they've learned to like the system," says Ammon. After seeing what it can do, they've come to recognize that the alternative is to spend a lot more time on the phone with patients. And the connection with the EMR means no taking charts out of the office—always a dangerous act—and no dictating at night. "The doctors recognize that these are steps we have to take to improve communication with patients and nurses, and generally improve care," says Ammon.

Medical Director Thomas Bat saw the advantages of jumping into the computer age, but was only marginally computer literate when changes started. Today he's completely proficient on it. "One of our main goals is patient access," he says. "Not only that patients see their doctors when sick, but that patients are able to interact and get test results, refills, referrals, and so on."

Savings are $4,600 a day, $1.25 million a year

The Televox software (which also facilitates outgoing calls to remind patients of appointments) cost North Fulton $20,000. The main office and its satellite have 15 LabCall stations in all. The entire phone system plus the Web site's encrypted e-mail system cost another $40,000. The 80 flat-screen computers in both offices cost $64,000.

It was a major outlay, but those costs plus other expenses incurred by expanding the practice have tripled patient volume and reduced per patient costs by more than 10 percent, says Ammon. In early 1999, before the practice installed the new phone system and Web site, four doctors saw a total of 2,000 patients a month. Last year, seven doctors and five physician assistants saw 6,000 patients a month. "And our per patient costs have dropped from $94.17 in 1999 to $86.16 in 2002, and that takes into account expansion costs and new employee benefits," says Ammon.

"We eliminated the $103,000 a year previously spent on transcription, reduced medical records clerks from four to none, saved approximately $46,000 on chart handling and searches, and $24,000 on medical records materials. We also saved on postage, printing, and handling costs. The practice's growth strategy resulted in an estimated savings of $4,594 per day or $1,249,568 for the year," he says.

Another advantage: "The integration of the telephone, Internet, and EMR reduced the load on our overtaxed phone system by 20 per cent," says Medical Director Thomas Bat.

 

Dorothy Pennachio. High-tech phones: Saving way more than a buck or two. Medical Economics Jun. 6, 2003;80:84.