High Stakes, Difficult Choices

Gary Baldwin
Health Data Management Magazine, October 1, 2008

Long choked with paper, and burdened with workflows that they don't fully understand, physicians in group practices have good reason to embrace electronic health records and integrated practice management systems. No wonder they may think of the automated chart as digital candy. And they want to try as many high-tech features as possible.

"There are many more priorities than anyone could actually do," sighs Carol Dresser, system director of information systems at Boston-based Hallmark Health. The two-hospital community delivery system is in the early stages of delivering EHRs to its 400 affiliated physicians. But as Dresser-and many other EHR veterans-point out, the sky is not the limit when it comes to selecting vendors, deploying systems and figuring out long-term strategic goals.

Following are snapshots of six group practices, ranging from newcomers to grizzled veterans, each of which has tackled the what-do-we-do-next question in unique ways.

AN I.T. NEWCOMER FACES 'BIG TIME' RESERVATIONS

Practice: Park City Healthcare

Location: Park City, Utah

Type: 10-physician family medicine

EHR Experience: Just beginning

Priority 1: Get the right vendor

When Bill Pidwell began the hunt for an EHR vendor for Park City (Utah) Healthcare early this year, he knew exactly what he wanted. Doubling as CFO at the 10-physician family practice, Pidwell wanted a system that was: a) affordable; b) user-friendly; and c) integrated clinical documentation with practice management functions.

After considering some 10 vendors, Pidwell opted for Carrollton, Texas-based iMedica. Although Pidwell's contract prohibits him from revealing the cost, he did say that the vendor's initial quote-about $37,000 in start-up costs-was "steeply discounted." That was largely his own doing, as the cost-conscious CFO pitted iMedica against runner-up Greenway Medical Technologies, Carrollton, Ga. "The two systems were close enough, so I played hardball," he recalls. "iMedica decided they wanted a foothold in Utah and figured we would be a good starting point."

But money was not Pidwell's only priority. He knew that any system would need to be easy to use, or it would never fly among his colleagues. "They had big-time reservations. They worried it would slow them down."

The vendor left a tablet PC loaded with the system at the group's disposal. The soft sell worked. "I was happy with it after two hours, so that was a good sign," Pidwell says.

Other software vendors, including Westborough, Mass.-based eClinicalWorks and Waukesha, Wis.-based GE Healthcare, did not pass muster, so they fell by the wayside during the evaluation.

Park City's new software, which the practice is rolling out now, easily swaps data between the clinical note and the practice management side. For example, it has a feature that enables the front desk staff to scan the bar code on a patient's driver's license and import the data automatically. Because the practice serves many tourists in the ski resort, that feature is valuable, Pidwell says. He also was lured by the technology's built-in patient education materials.

Despite the potential, Pidwell knows the next few months will be challenging. "Our first priority will be getting physicians comfortable with the EHR. We want them to go from paper charts to the EHR without throwing the tablet across the room."

Pidwell's already cooking up ways to accomplish that. Using practice management data, he wants to revamp the group's compensation scheme to include production-based bonuses. His other long-term goal is wrapped around quality. "The EHR will provide electronic reminders for health maintenance, such as follow-ups for labs and annual physicals. We want to enhance our patient call-back system. Right now we have no way of doing that. That is poor medicine."

EHR 'WENT IN BACKWARDS,' BUT WORKED OUT

Practice: Huntington Internal Medicine Group

Location: Huntington, W.V.

Type: 60-physician, multi-specialty

EHR Experience: 2.5 years

Priority 1: Proper staging of modules

When Huntington Internal Medicine Group moved to a new facility in the beginning of 2006, it saw EHR technology as a way to avoid moving paper charts. Thus, it implemented clinical documentation software first, later abandoning its legacy practice management system for integrated technology. "We went in backwards," says Jonna Huges, director of clinic operations. "I would not recommend doing it that way, but it worked out OK."

The group wound up carting paper charts to its new offices. And it is still relying on transcription to get encounter notes into the electronic record, from Tampa-based Sage Software. Yet, Hughes prioritized the roll-out of clinical documentation modules in a way that facilitated physician acceptance.

Out of the gate, the practice deployed the system's e-prescribing module, which dispatches prescriptions directly to local pharmacies. "It is something the staff can help facilitate," she observes. "They could enter the meds from the paper chart, the physicians could look at them easily and they only needed a quick click to send."

That feature helped improve the exchange of information in the multi-specialty group, where patients often see a primary care physician and sub-specialist during one visit. "The meds can be updated and in the hands of the next physician right away," Hughes observes.

At the same time it enabled e-prescribing, the practice fired up a tasking feature, which it uses to document phone calls and route orders. A patient requesting an office visit, for example, may need a CT scan. Using the technology, the nurse could set up the test using the tasking feature.

"We began to fill the record with day-to-day information-all the things that used to go on post-it notes," Hughes recalls. "It became a permanent part of the record and it was easy for physicians to use."

During the first year of the roll-out, the practice imported historic records that dated back five years. Some records, such as lab data and transcription, were imported through interfaces. Other paper records, such as encounter notes and externally generated documents, had to be scanned. Hughes set up 15 stations, using document scanners from Secaucus, N.J.-based Panasonic, throughout the facility. "It is important to keep the outside flow moving," she says. In the end, the group imported about 1 million lab reports.

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