How To Use An Emr

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Cecil Bailey
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1 EMR Technologies: How They ve Changed the Office Scott W. Johnson, MBA Administrator Digestive Disease Associates Gainesville, Florida October 23, :15 11:30 am 1 DDA~Gainesville, FL 2006 Thomas R. Beers, MD Gabu Bhardwaj. MD Theodore W. Burns, MD James W. DeFord, MD John R. Leibach, MD Brief bio on DDA: Practice established by Dr. James W. DeFord, 1979 Board certified in Gastroenterology and Internal Medicine Jared C. Kniffen, MD (deceased) Daniel G. Maico, MD Enrique G. Molina, MD Shea O. Ross, MD Charles A. Sninsky, MD Renata Wajsman, MD 2

Thomas R. Beers, MD Gabu Bhardwaj. MD Theodore W. Burns, MD James W. DeFord, MD John R.

2 Current Staff and Services: 9.25 Physicians 2.5 Physician Assistant s 1 Nurse Practitioner 39 FTE s 22 treatment rooms 5,500 square foot, 5 procedure room Endoscopy Center GI coverage for two hospitals, Alachua General Hospital and North Florida Regional Hospital. Given Capsule Endoscopy and ESO Pillcam Bravo and ph manometry 3 Software/Hardware Technical Logistics: High-speed DSL internet capabilities Software include: Practice Management- QRS/Paradigm Electronic Medical Records- A4 Health Systems Endoscopy reporting- Provation Given Capsule Endoscopy Hardware includes: 72 PC s 5 scanners 5 fax machines 4

hospitals, Alachua General Hospital and North Florida Regional Hospital.

3 DDA Primary Reasons for looking into an EMR: Reduction of chart pulls for Medical Records Improve quality of the Medical Record Reduction of staff searching for charts Reduce staff time at off site storage Chart room floor space needed for clinic treatment room growth Reduce Transcription volume and costs Improve Chart access 5 DDA Secondary reasons for looking into an EMR: Reduce cost of supplies such as folders, tabs, dividers, and shelves Reduce off site storage of records Reduce Medical Records staff 6

treatment room growth Reduce Transcription volume and costs Improve Chart access 5 DDA Secondary reasons for looking into an

4 Additional benefits that DDA believed would occur: Improved timing of filling prescriptions Possible coding improvements Improved completion of patient history, data entry to be made available to the patient 7 History of DDA s EMR Research process, How? Who? What? Began research into an EMR in May 2000 February 2001 convinced that there was no EMR that would work Discussed the development of a word based program to store patient charts PC s were purchased and installed in all treatment rooms and for key staff 8

5 History of DDA s EMR Research process, How? Who? What? High-speed internet service was established Word based program was cumbersome, back to researching EMR s in late 2001 January 2002 June 2002, committee previewed document storage programs and 3 EMR programs for demonstrations. June 2002, DDA had A4 in for a demonstration 9 History of DDA s EMR Research process, How? Who? What? DDA purchased the A4 system in mid August 2002 Customization training in North Carolina October 2002 In house training mid November 2002, went live Thanksgiving 2002 February 2003, greater effort in customization and using the program 10

previewed document storage programs and 3 EMR programs for demonstrations.

6 History of DDA s EMR Research process, How? Who? What? Four years later, we continue to grow the program 11 Why A4 Health Systems was chosen? Past interface with our PM system Ability to customize to meet the needs of our specialty Offered the critical features that we needed Appearance of a solid support system Competitive cost of product Compatibility with existing hardware Vender stability Coding tool Seemed to be user friendly 12

Past interface with our PM system Ability to customize to meet the needs of our specialty Offered the

7 Top 22 Hidden successes as a result of the EMR: CHART ACCESS! 2. Improvement in Messaging between Patient/ staff, staff/ Physician 3. CHART ACCESS! 4. Improved documentation of the messages 5. CHART ACCESS! 6. Reduction of patient wait time to treatment 7. CHART ACCESS! 8. Improved process flow of material 9. CHART ACCESS! 10. Protocols reviewed between Physicians 11. CHART ACCESS! 14

Reduction of patient wait time to treatment 7. CHART ACCESS! 8.

8 12. Resulted in great updates to clinic policy & procedures 13. CHART ACCESS! 14. Legible charts, prescriptions 15. CHART ACCESS! 16. Staff retention 17. CHART ACCESS! 18. Transcription Cost Reduction 19. CHART ACCESS! 20. Messaging 21. CHART ACCESS! 22.CHART ACCESS! 15 Pains and lessons learned: 1. Understand that everything that can go wrong in a paper chart can also go wrong in an electronic chart 2. Must embrace and be ready for change 3. Be ready to review all clinic workflow 16

CHART ACCESS! 22.CHART ACCESS! 15 Pains and lessons learned: 1.

9 Must establish clear communications with support early on in the process Inventory your equipment, Is it located for efficiency? During implementation, don t try to do too much at one time Don t expect to reduce staff in the first months Customization is very time consuming, allow for this time Don t purchase all the gadgets at first Be ready to establish implementation strategies and incentives 17 Do not underestimate the volume of scanning that may be needed Understand that no system will solve 100% of your needs BE PREPARED TO SPEND TIME CUSTOMIZING THE SYSTEM 18

consuming, allow for this time Don t purchase all the gadgets at first Be ready to establish implementation strategies and incentives 17 Do not

10 Rough ROI to date: Transcription costs: 63% reduction in Transcription costs through the first 3 quarters of use. (Prior to EMR transcription costs were approximately $109,000 per year, or about $9,000 per month. Now down to less than $1,500 per month). At current level of providers this is a savings of $140,000 per year. 19 Retrieval of charts: $3 per chart pull average 200 charts per day, 254 business days =$152,400 per year Chart supplies: 38% reduction in 5 months (over $7,000 of savings). Currently recognizing a $19,467 savings in supplies annually. 20

At current level of providers this is a savings of $140,000 per year.

11 Staff reduction: 5 positions reduced (at months). Wages and benefits = $130,200 per year Physicians gained minutes per day in office efficiency. 21 Change in office workflow and advantages: At 8 months of use, all providers using the system Efficiency of the returning patient Great reduction in time to retrieve a chart Opportunity to review all clinic processes Opportunity to update patient history 22

21 Change in office workflow and advantages: At 8 months of use, all providers using the system

12 Recommendations and move to action for EMR selection: Narrow search to 3 vendors Request a proposal from each Consider Site visits Ask vendor to complete a patient visit, from check in to check out Assign a Positive staff member with a clinical perspective to the project full time Commit the proper resources to the process EMR vendors do not know your specialty or how you maneuver throughout the clinic Every day you wait, more paper is generated, leaving you with an even greater task Systems are getting better each month There is no good time to make the transition, it will always be a hard transition 23 Things we still wish to complete: Continued expansion of fast tracks Interface with Provation Explore the interface with charge capture and our PM system Patients submitting health history by way of web portal, to be dropped into the EMR. Continued customization 24

the clinic Every day you wait, more paper is generated, leaving you with an even greater task Systems are getting better each month There is no good time to make the transition, it will always be a

13 EMR Features to Observe Features associated with system Customization ability Messaging staff/ physician Lab interface Scanning ability Prescription writer Data collection and reporting Front Desk check-in/ out Health History data entry Order tests/ labs/ procedures Faxing capabilities Referrals to other physicians Web portal DDA~Gainesville, FL EMR Features to Observe License/ Support How is the product licensed What customer service support is available Is there a cost associated with the support DDA~Gainesville, FL

Faxing capabilities Email Referrals to other physicians Web portal DDA~Gainesville, FL 2006 25 EMR Features to Observe License/ Support

14 EMR Features to Observe Workflow Appointment scheduling /Check-in Messaging between staff Ease of Prescription refills Electronic Lab review Ease of reviewing / signing / filing scanned documents DDA~Gainesville, FL EMR Features to Observe Documentation Ease of documenting multiple problems What are the options for inputting documentation? Ease of applying a template to a visit How are Clinical Pathways addressed? Is there an E&M coder, see it in action How is a letter generated and sent to a Specialist? How is an addendum completed? How do they appear in the chart note? Explain how you triage orders? How much authority is giving to the MA s etc in regards to Chief Complaint? How long will it take our group to get the hang of it? DDA~Gainesville, FL

Ease of applying a template to a visit How are Clinical Pathways addressed? Is there an E&M coder, see it in action How is a letter generated and sent to a Specialist?

15 EMR Features to Observe Customization Have the vendor demonstrate how to create a template from scratch. Make sure it is an end user not a programmer How are our own terms added to the system? How are favorite medication lists built? Demonstrate how a letter template is created DDA~Gainesville, FL EMR Features to Observe Clinical Content What medical libraries of information come pre-loaded in the system? Do you recommend getting the application early and being able to have ample time to customize in advance or go live at 75% and keep massaging the content How best to do this? DDA~Gainesville, FL

Demonstrate how a letter template is created DDA~Gainesville, FL 2006 29 EMR Features to Observe Clinical Content What medical libraries of information

16 EMR Features to Observe Interfaces Does the practice have a live lab interface? What Lab systems does the EMR system currently interface with? What Lab systems does the EMR system currently interface with? Is there any integration with diagnostic equipment? If so what equipment Demonstrate the integration between practice management and EMR DDA~Gainesville, FL EMR Features to Observe Equipment Needs Which image formats will the system support Server needs Scanner needs What printers will the system support PC s vs. tablets Fax Press/ phone lines Wireless DDA~Gainesville, FL

If so what equipment Demonstrate the integration between practice management and EMR DDA~Gainesville, FL 2006 31 EMR Features to Observe Equipment

17 EMR Features to Observe Costs Software/ license Hardware Third Party Software Implementation and Training, Travel Customization Interfaces (PM, Endo) Annual Maintenance DDA~Gainesville, FL Scott W. Johnson, MBA Administrator Digestive Disease Associates Gainesville, Florida Phone: (352) , ext. 132 Fax: (352) Website: DDA~Gainesville, FL

Implementation of EMR

Implementation of EMR Paul Steven Collins MD FACS RPVI Assistant Clinical Professor of Surgery University of South Florida Bay Surgical Specialists St Petersburg, Fl No Magic Formula However, Fail to Plan,