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EHR Project is Something Special


By Zack Martin, Managing Editor September 2007
James Leavitt, M.D., says his first time using an electronic health record was an experience similar to the first time he drove a car: demanding and nerve wracking. "Every click was slow and tedious," says the executive director at the Gastroenterology Care Center of Miami. "Deploying an EHR is the most stressful thing I have ever done. You're blowing up the old way of doing things and changing everything."

The 13-physician practice deployed an EHR specifically designed for gastroenterology in October 2003. The gCare Medical Office system - from Weston, Fla.-based gMed Inc. - has cut costs by more than $175,000 annually though decreased transcription costs and elimination of three full-time positions. It also increased evaluation and management revenue by $155,000 annually by automatically coding documentation, Leavitt says. The practice estimates its five-year return on investment for the software will be in the neighborhood of $1.2 million.

Along with the cost savings, the software has paid off in a way everyone can appreciate: physicians are finishing their work and leaving 30 minutes to an hour earlier each day.

The cost savings began accumulating right of the box; since the software was designed specifically for gastroenterology, the practice avoided costly programming that's required to customize drop down menus, templates, lists, coding logic and documents for specialists, Leavitt says. It also supported his strategy to get physicians up and running quickly, Leavitt says.

Software vendors that tailor EHR systems for specialists have a competitive advantage in today's marketplace. Physicians are more aware of the time and money involved in customizing EHR products and are "more likely to sit there and listen" to specialty vendors, says Vinson Hudson, president at Jewson Enterprises, an Austin, Texas-based consulting firm.

Specialty EHRs also often cost less, Hudson says, because small vendors focus their development and support on the software and don't have to hire talent to design and support a range of products. However, physicians need to confirm that specialty software really is special. Practices should look for endorsements from independent associations and other reputable organizations within their specialties to ensure the software has truly been customized.

But whatever type of specialty software a practice is installing, the old adage still applies-the technology is designed to improve, not mimic, work processes for a paper environment. "Workflows will have to change - an EHR won't make a shabby operation more efficient," Hudson says. "You have to look for inefficiencies in the processes and change them."

At Gastroenterology Care Center of Miami, inefficiency was on display Monday mornings at the fax machine, Leavitt says. Over a typical weekend, more than 600 faxes of lab and radiology reports and various other documents would pile up.

It usually took two or three days for those paper forms to be reviewed, completed if necessary and added to a patient's chart. That same process now takes an hour. The gMed EHR links with the outside laboratory's network so physicians receive results electronically. Doctors also can send messages to their assistants and other support staff via the EHR, and the electronic charts are available 24/7, so precious time is no longer wasted tracking down files.

The efficiency gains are spread out across the mundane tasks that can clutter a work day. For example, in a paper environment, prescription refill requests required a physician to get their hands on the paper chart and review it before authorizing a refill. The EHR has dramatically simplified the process. "It used to take me six to 10 minutes to do a refill, but now a request goes to my task list and the patients' chart is attached," Leavitt says. "I can send it directly to a pharmacy, and the entire process takes me less than a minute."

But getting to this point wasn't easy. Some of his physician partners didn't want to make the switch, so Leavitt and other EHR proponents had to work hard to win over that recalcitrant group. "You have to develop a culture of change or culture will eat the change for breakfast," he says.

The practice deployed the software quickly, but took a step-by-step approach. The most enthusiastic physicians went live first. Each week, a trainer would work with two or three physicians to get them comfortable with the application and the new workflows it created.

By the time the practice introduced the software to the small group of skeptics, most of the bugs had been worked out of the system, Leavitt says.

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