As
printed in "Cardiology Practice Advisor", May 2001
You've
heard all the claims of how implementing electronic medical record
keeping (EMR) can benefit your business - improved accuracy, greater
efficiency, better allocation of resources, enhanced patient care,
to name just a few. And that it's all supposed to create a healthier
bottom line. In fact, many tout the technology as the elixir that
can take your practice to new levels of productivity and profitability.
But it's not without its downside. EMR can carry a price tag beyond
the actual cost of the software and additional hardware. Putting
EMR in place often means replacing and displacing employees. Policies
and procedures change and staff may find themselves in a new role
or no role.
To
provide you with some perspective and real-life accounts of EMR
implementations, we talked with some cardiology groups about their
experiences. We wanted to know - and figured you'd find the information
useful - whether all the buzz about EMR is valid or just so much
hype. This month we're giving you Mid-Carolina Cardiology's story.
We'll report on others in later issues.
Some
pain, much gain
Mid-Carolina Cardiology operates seven office sites with 25 cardiologists
throughout the Charlotte, North Carolina region. About two years
ago, the practice undertook what started as a search to upgrade
its billing software and to concurrently implement EMR. By the time
the journey ended, the doctors and managers had installed a sophisticated
clinical information system that led to a total overhaul of just
about every operational procedure.
John
Whitham, chief operational officer, says the practice's installation
of Gateway Electronic Medical Management System (GEMMS) challenged
them in many ways. It brought about substantive changes in functions
and job responsibilities, and the practice even lost some personnel
as a result - a possibility the group had anticipated.
GEMMS
makes the unique claim of being specialty-specific to cardiology.
Its CEO Rodger Pinto served the well-known Indianapolis group then-called
Nasser, Smith and Pinkerton as an administrator and headed its system
development team from which GEMMS was born. While Pinto considers
his system the ultimate for cardiology practices, he still recognizes
that it's only as good as the people installing and using it.
What
strengthened Mid-Carolinas Cardiology's efforts, first and foremost,
was the voice of strong physician leadership. Establishing an EMR
implementation committee of key staff - including cardiologists
- helped to guide the process and keep them on task. The committee
is still intact, Whitham notes, but it meets less frequently now.
It continues to look at ways to further develop and enhance use
of the system.
Technology is simply a tool
Two key understandings are vital to successfully implement EMR,
in Whitham's experience. First realize that technology can help
you make improvements. You won't just install it and find that it
works wonders. Second, you have to be open ad ready to make operational
changes, because inevitably you will re-engineer your practice.
"It's
important to stand strong and present your implementation plan as
the direction in which the practice is going, period. You can't
view the plan as optional or uas useful for some functions but not
for others."
You must also realize that you'll face up-front costs beyond the
system licensing and training. Mid Carolina Cardiology had to install
T-1 communication lines and increase IT (information technology)
support. But even those extra expenses were quickly offset by cost
savings and increased revenue, says Whitham.
Staff efficiencies can raise revenue.
Mid
Carolina's physicians found that they could optimize the use of
staff in new and different ways. One major organizational change,
for example, grouped staff into fictional teams comprising physicians,
nurses and medical assistants. The cardiologists no longer each
had their own nurse. That took some getting used to, as you can
imagine, but it also freed the nursing staff to perform more diagnostic
testing. And the increased testing generated more revenue.
The
group's medical records staff also used their time more effectively.
Whitham estimates that, before installing GEMMS, about four of the
12 medical records FTE's spent full-time tracking down paper patient
charts. Now this staff more efficiently captures and manages patient
data to support practice operations.
