It will be the electronic records system, though, that widens access to patient data, enhances practice patterns and ends the group's dependence on paper.
"So much of what we do in the paper world is repetitive," Greaves explains. "We ask for the patient's name and date of birth over and over." Soon, all such data will flow from Primary Care Associates' practice management application into its electronic records system.
Helping the provider
"And it will migrate back to the physician's note," he adds. "That will help the provider determine the appropriate level of coding. Data then returns to the practice management system and drops into the claim."
Primary Care Associates is among a small but growing faction of group practices that believe these two applications together can improve patient care and operating efficiency. They also believe these information technology tools will become status quo in the new world of performance-based patient care contracts and reimbursement.
What these groups seek is access to information, which will improve operating efficiency, charge capture and patient care, says Rosemarie Nelson, senior consultant at Medical Group Management Association, an Englewood, Colo.-based trade association for group practice administrators.
"A paper chart just can't be made more accessible," Nelson says. Physicians complete nearly a third of all patient encounters without a patient's chart in-hand, she notes. "The chaos of the paper chart is a huge driver. It's the one thing people want to fix."
Data culled from a March 2004 MGMA member bi-monthly survey indicated that 27% of 355 responding group practices had electronic health records systems in place.
Improving care quality and documenting results are key factors for providers who implement both practice management and electronic records systems. Plus, electronic data can be searched easily, a critical factor in last year's recall of the Vioxx pain medication, Nelson says.
Mind over paper
Group practices also run more efficiently with the twin applications in place, experts say, enabling many to eliminate or reassign labor. "Reassigning office staff means people get to take on roles with higher responsibility," Nelson explains. "There is no longer so much mindless paper-pushing. With more access to information, people are working at a higher level, providing more value and better service."
Nelson notes that group practices have shown increasing interest in electronic records systems in the past 18 months. "I've worked with a lot more groups who went from the system-search phase to selection, and then signed vendor contracts. In the past, they might have searched then said `let's wait a bit.' "
Some groups are turning I.T. up a notch because they foresee greater reliance on outcomes-based reimbursement and potential economic incentives from Medicare to communicate electronically. "A lot of groups are responding to the need to get better at demonstrating the quality of their services," says Margret Amatayakul, president of Margret\A Consulting, a Schaumburg, Ill.-based health care I.T. consulting firm. "They need data to support quality of service for pay-for-performance initiatives."
Physicians also are addressing quality issues of a different sort with these combined applications. "Doctors today say if they can't make as much money as they did in the past, they will address the quality of life factor," she explains. "That includes seeing the data they need at home or wherever they might be, and not staying late to complete charts or review prescription refill requests."
Group practice physicians also are beginning to feel pressure from tech-savvy patients who expect doctors to be automated, Amatayakul notes. "Otherwise patients will think, `If my doctors aren't using an electronic health record, what else aren't they keeping up with?' "
The path group practices take to add one or both systems varies, with some groups implementing or upgrading practice management systems and then adding electronic records technology. They are mindful of the weighty costs associated with integrating systems from different vendors, many say, and so tend to give careful consideration to existing vendors that offer both applications.
Costs to install both types of full-function systems can range from $20,000 to $50,000 per physician, Amatayakul notes, with those integrating systems from different vendors at the top of the scale. Less expensive systems are available, but she cautions against spending less than $10,000 per physician because of limited functionality.
In some cases, the add-on is the electronic medical records application, often from a group's existing vendor. In other cases it's a second-generation practice management system. But group practice decision makers will bite the integration bullet and deploy disparate systems for the right reasons, including satisfaction with an existing vendor's product and performance of the individual applications.
Some group practices take pains to stick with one vendor, helping to develop one or the other of the two applications. But Amatayakul advises against excluding other vendors from consideration.
"If the group has an incumbent vendor for one and is happy with that vendor and feels it has kept products up to date, that vendor should be in the mix for evaluation," she says. "Looking at others keeps the incumbent vendor on its toes. If a system is working well, that's a plus. But it's not absolutely essential they be from the same vendor."
Group practices that choose separate vendors for practice management and electronic records systems can expect maintenance costs beyond the upfront outlay for an interface. Software upgrades will incur labor expense, as will adding other functions later, such as e-prescribing software. "Physicians need to understand there will be greater costs over time," she adds.
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