Each advance, however small, leads to more efficiencies. Before getting an EHR at Hillside Medical Office in Wichita, Kan., phone messages for nurses were written on paper. Now they're put directly in the EHR while the operator is talking to the patient. There are no more lost messages from a patient who never got a response.
"We know who took the message, when they took it, what the message was and who they sent it to," says Dave Gordon, practice administrator. "The person who answers the phone calls up the patient name and puts in the message, tasks it to a nurse and the message is instantly in the patient's chart and pops up on the nurse's screen. That creates efficiency throughout the whole building. It's not a lost transaction."
But it gets even better when an EHR is interfaced to a practice management system, Gordon says. A Hillside coder working in the practice management system-which is on the same platform from Pulse Systems Inc. as the electronic record-can click on a patient chart in the EHR and look at the actual physician notes to determine if the encounter was appropriately coded.
Billing staff in the PM system's accounts receivables module can click over to any needed clinical information in the EHR. Front desk staff or clinicians answering patient phone calls can click over to the patient chart during the call and answer questions rather than hunt down the paper chart.
Transcription costs have gone down, as have costs for managing paper charts, "not to mention the frustration when that chart could not be found or was being used by another person," Gordon says.
"Granted, we have more expenses associated with computers, but I haven't determined the exact dollar offset. But that's unimportant-there's no way we would go back to the paper format," he adds.
Running the numbers
Physician I.T. consultant Steven Lazarus, however, has run the number for clients, and the math adds up.
One, a money-losing, 15-physician cardiology group practice that adopted an integrated EHR/PM system, created efficiencies that paid for the new system in just one year, says the founder of Denver-based Boundary Information Group.
"Practices that figure this out will make a lot of money and have happy patients who won't want to go anywhere else," says Lazarus, ticking off the clinical and financial windfalls for combining EHR and practice management efficiencies: better data capture that reduces lost charges; improved coding; automated patient reminders; and proper follow-up treatment of chronic patients, among other benefits, can help a practice's revenue grow.
But it doesn't necessarily happen overnight. Eighteen months after going live on an EHR from gloStream Inc., Troy, Mich., Julie Hopkins, practice manager at BayView OB/GYN in Petoskey, Mich., noted such efficiencies, but only now is indentifying the financial impact.
The practice has a large Medicaid population and has had its reimbursements cut in that business segment, but while overall revenue is down, net income is up. "While I can't pinpoint all the efficiencies, we're running more efficiently with fewer errors, and the result is better performance all around," Hopkins says.
Seeking domino effect
Practices that become adept at using EHRs, however, sometimes face problems with "throughput" to their practice management systems. To get the full benefits of an EHR/PM integration requires clinicians and administrative staff to upgrade their practice management skills.
Steven Seligman, M.D., co-founder of Omega OB-GYN in Arlington, Texas, notes that clinicians rarely go near a practice management system. But as a clinician and administrator, he's finding previously untapped but useful PM functions now that his EHR is up and running.
For example, he can be in the EHR while talking to a patient on the phone, and toggle to the practice management system to check the patient's next appointment and remind them about it during the call.
He also runs PM reports showing monthly collections and staff productivity, and can access a physician's schedule for the next day and if necessary add a patient to the schedule.
Gail Burdine, administrator at Omega OB-GYN, is using the EHR/PM integration to cut several steps out of the billing process. Omega uses a combined, single database system from Greenway Medical Technologies, which takes an electronic superbill created in the EHR to generate a claim in the PM after billing staff review.
Six months after getting the combined system in 2004, billings and collections were up 16 percent, she adds. Seven years later, the practice is run by four billing FTEs and one collections staffer. Prior to the EHR, Omega had up to five FTEs managing records, work now done by a single employee. And two physicians have been added without an increase in billing staff.
"Reimbursements for what we do are trickling downward. If that's how it's going to be, then we need better ways to get the claims downstream. These are all little things, but they add up to better efficiency."
Next steps
At BayView OB/GYN, the implementation of an electronic record has given staff the confidence to dig deeper into the practice management system.
After the practice's first EHR went live, the provider replaced its practice management system because the vendor was not cooperative in integrating it with the electronic records system.
During the intervening 10 months before a new PM was in place, staff got comfortable with the EHR.
When the new practice management system was in place, the staff got "braver" with the software, Hopkins says: front desk employees, for example, started looking deeper into billing and insurance information and resolving issues, instead of shoveling all patient billing questions to the billing staff.
