Western Surgical Group began implementing an electronic health records system in January 2006, a few months after installing a practice management system from the vendor. Major sources of savings from the EHR for the 13-surgeon practice in Reno, Nev., have included:
* trimming 10 positions, including medical records and front desk staff, at an annual savings of $250,000;
* eliminating a monthly transcription bill of $6,000; and
* ending the rental of 2,200 square feet of office space for paper record storage to save $4,500 per month.
Getting most of the surgeons who co-own the practice to buy into the concept of electronic records was relatively easy because the physicians are technology savvy, says Jim LaBorde, CEO of the practice. "They always like the latest and greatest on the surgery side and the technology side of the practice," he says.
The physicians and staff at the practice's two locations liked the idea of buying an integrated practice management and electronic health records system from one vendor to ease the flow of information, he says. The practice phased out a practice management system from Sage Software Healthcare, Tampa, Fla., and selected integrated practice management and EHR software from Greenway Medical Technologies Inc., Carrollton, Ga.
Implementing the records system, however, was easy for some and difficult for others, the CEO acknowledges (see sidebar, page 45).
A Gradual Shift
Because the practice had heard horror stories about interruptions in work flow caused by a rapid shift to EHRs, it chose to gradually phase in the records system.
At first, doctors used electronic records for two patients in the morning and two in the afternoon. Then, they gradually added more as they achieved a comfort level.
"Some we had to hold back because they caught on quickly and wanted to convert to 100% electronic in a month," LaBorde says. "Others had to be pulled along."
An in-house trainer helped all physicians and nurses learn the system, tweaking templates that Greenway provided.
After a six-month phase-in, all clinicians stopped using paper charts and dictation. They turned to point-and-click templates and limited typing instead.
To get rid of paper while minimizing the cost, the practice's staff scanned only the most important categories of information in all historical records as pinpointed by physicians, LaBorde says. Western Surgical used scanners from Fujitsu Computer Products of America Inc., Sunnyvale, Calif.
"If there were any other documents within a particular chart that a physician felt needed to be in the electronic record, they tagged them for scanning," he adds. The practice continues to store 10 years worth of historical paper records in lower-cost off-site storage to comply with state regulations.
To provide physicians with easy access to the records system, the practice originally used tablet computers in conjunction with some docking stations with keyboards. But it eventually phased those out in favor of convertible tablets, which have keyboards attached, from Toshiba America Inc., New York.
The surgeons believed mobile computers would be far more practical and secure than desktop devices in every room. That's because doctors using desktop PCs would need to log on and off those computers to protect privacy, says Ashleigh Conder, the practice's electronic records specialist.
Now that the practice has resolved the device issue, it is turning to addressing data sharing issues. The practice sends and receives images of records to local hospitals using an electronic fax service. The surgeons hope to eventually exchange records electronically with the hospitals as they implement EHRs and build networks, LaBorde says.
Doctors can access their records from home using Gotomypc technology from Citrix Systems, Fort Lauderdale, Fla. The technology encrypts data accessed over a virtual private network.
The next automation project on the horizon for the surgical practice is a shift to electronic prescribing.
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