|The Truth about ROI and EMR|
Why computerize your medical records?
By James Bolling, M.D. Jacksonville, Florida, USA
Article published by OPHTHALMOLOGY MANAGEMENT, September 1997
Three years ago, our 200-doctor, multispecialty clinic decided to go paperless. At a cost of $ 24 million, we developed a stable power supply and installed 1,200 work stations and a redundant fiberoptic network. We chose software from five different vendors. We also hired additional information systems employees and outsourced some technical jobs. Has it been worth it? The answer from our staff and administration is unequivocal “yes!” What follows are the reasons why, from a perspective that you and your staff might appreciate.
Why should you bother with computerized medical records? Because we’re in the middle of a technological revolution. The cost of labor is getting progressively higher, and the cost of technology is dropping. For example, when you go to the grocery store, the clerk enters your items in the cash register with a laser scanner. Many gas stations let you use your credit card at the pump, without talking to anyone. Businesses have adapted these innovations to save money. In each case, a computer does the work that was previously done by a person. What does this have to do with ophthalmology? Medicine, like any business, is becoming more competitive and we’re being asked to increase efficiency and productivity. With current technology, computers can’t replace doctors, but they can replace the clerical help we rely on to move and maintain our medical records. For example, in the average practice it takes 5 minutes to find a chart, prepare it for the doctor and then re-file it. If a practice sees 12 patients an hour, then filing charts becomes a full-time job for one person. In our practice we’ve eliminated a full-time job of mailing, receiving, labeling and filing color slides and fluorescein angiograms by investing in a digital imaging system. All of our images are stored on a computer network that extends to all the exam rooms. Under this system, you can review images from any work station at any time. How much cost you can save by going to an electronic medical record depends on how expensive it is for you to maintain your records now.
As the pressures of a busy practice mount, many of us find it increasingly difficult to write down every detail of a complete eye examination. In particular, many doctors may leave out negative findings because it is the positive findings that direct our care. However, cutting corners can reduce quality of care, and can also increase our malpractice liability. For example, the fact that a patient denied having a headache may be important if he has a stroke after leaving your office. Legibility is another increasingly important aspect of documentation. As we all know, continuity of care isn’t what it used to be. These days, it’s increasingly common to review other doctors’ records. One way to improve legibility is to dictate your notes. This lets you communicate a lot of information both quickly and legibly. You can streamline the process by creating a preset word processing document, called a template. If the entire examination is normal, you can dictate “normal examination, per template” and your transcriptionist and you can save time by using preset blocks of text called “macros”. There are, however, significant problems with dictation. First, it’s difficult to assure the accuracy of a dictated clinical note. Second, dictating numbers can be very difficult. For example, something as simple as entering a patients’ eyeglass prescription becomes a nightmare with dictation. First, your technician reads the lenses with a lensmeter and writes the prescription on a piece of paper; you read the prescription into a tape recorder or digital recording systems; and finally, a transcriptionist listens to the string of numbers and types in your notes. A task that involved only one person in the past now involves three people. In our practice, we solved this problem by interfacing a semi-automated lensmeter with a computer program. This lets one staff member enter lensmeter measurements directly into the medical record without writing anything.
Electronic medical records have undoubtedly increased my efficiency. Whether or not they’ll improve your productivity will depend on how you’re performing now. Let’s consider a few examples. As you know; when you write a prescription, you have to record the prescription both in the chart and on the prescription pad. If the information is in an electronic format, many software programs will let you easily print the prescription from the information that’s in the chart. If you send a lot of time looking for charts or looking through charts for assorted data, then you’ll find that putting your charts on a computer is another way electronic medical records can save you time. Imagine this: When your office takes calls from patients, their medical records will be instantly at your fingertips. Another way you can save time with electronic medical records is by using computer-generated-letters. If the date in your medical record is in a database format, the fields can be inserted into a preset word processing document to produce a letter that’s sent to a patients’ referring physician. Communicating with your staff can also be simplified. If you are treating Mrs. Smith and you want the secretary to call the patient to set a date of surgery, you can make the request from your workstation without picking up the phone or looking into the hall.
Putting it into practice
The process of incorporating electronic medical records into your practice can be one of short-term misery for long-term gain. Choosing the right hardware and software, for example can be both intimidating and expensive. What works well for one practice, may not work at all for yours. The products you purchase must be based on an analysis of your current practice. The samples “productivity analysis worksheet” can give you an idea of how to calculate what computerized medical records can save your practice in terms of time and money. Other factors you must consider how to train your staff to use computerized medical records and who to use for technical support. You will also have to become familiar with the legal requirements for maintaining electronic medical records in your state. The regulations vary, so make sure you have someone check. Another important consideration: You’ll have to make provisions for securing and backing up your system. The transition from paper to computerized patient records can be painful at times, but switching to an electronic medical record system may mean staying competitive in the future. It’s a choice only you can make.
(Dr. Bolling is an ophthalmologist at Mayo Clinic Jacksonville. He’s a retinal specialist and has been using computerized medical records for 2 years when he wrote this article)