American College of Physicians Annual Session Philadelphia, Pennsylvania April 6-8, 2006 Practical Steps toward a Paperless Office Faculty Jeffrey P. Friedman, MD, FACP Disclosure Stock Options/Holdings:NexSched Disclosure Robert J. Lamberts, MD, Member No significant relationship to disclose. Posted Date:March 24, 2006 Educational Disclaimer: The primary purpose of the Annual Session is educational. Information presented, as well as publications, technologies, products, and/or services discussed are intended to inform participants about the knowledge, techniques, and experiences of the faculty who are willing to share such information with colleagues. A diversity of professional opinion exists, and the views of Annual Session faculty are their own and not those of the American College of Physicians. The ACP disclaims any and all liability for damages and claims which may result from the use of information, publications, technologies, products, and/or services presented at the Annual Session or distributed in association with the meeting. 2006 American College of Physicians. All rights reserved. Reproduction of Annual Session presentations, or print or electronic material associated with presentations, is prohibited without written permission from the ACP.
Practical Steps Toward a Paperless Office and Realized Efficiencies ACP Annual Session April 7, 2006 Jeffrey P. Friedman MD, FACP Founding Partner-Murray Hill Medical Group, PC Clinical Associate Professor of Medicine, NYU School of Medicine Managing Partner-NexSched friedj03@med.nyu.edu Assumptions We all want to practice high quality medicine Our patient populations are similar Our reimbursement is not very different Manhattan expenses are not inconsequential We expect to practice at least another 10 years We want to be happy Agenda Murray Hill Medical Group A History 1992 4 Partners, 2 Associates 8 employees, POL 1 exam room per doctor No ancillary help Office staff all generalists re billing, appointments Local small electronic billing package History 1995 Added 5 partners (including subspecialists). 5 associates Added EGD, Colonoscopy, Echo, EST, Holters as profit centers Built out more space Upgraded PMS and added Electronic Scheduling Staff became specialized History 1997-1998 Added partners and associates Added more space Started with EHR ( Logician) 1999-2000 Added associates Added more space 2001 Added Internet scheduling Letter/ Lab/Mail Merge 1
History 2003 Added Anesthesia Services Added associates 2004 Added On-line Refills and Referrals 2005 Hospitalist Rehabilitation Medicine Podiatry Added associates 2006 New PMS Bill Paying On-Line Email Patients Murray Hill Patient Statistics 95% have Internet access 25% have Medicare 15% are PATOS 60% are fee for service managed care No patients are capitated managed care MHMG Stats 2005 Income is Productivity Based Partner Expenses for 2005 =$60,000 Income for Internists and Subspecialists is 2-3x the national average Expenses for malpractice, 401K and Profit Sharing is paid by the practice Practice Overhead for 2005 is 39% Employee/Doctor Ratio = 2.3 Agenda What does Paperless Mean? Electronic Medical/Health Record (EMR/EHR) Electronic Billing/Reporting Practice Management System (PMS) Electronic Scheduling Scanning Inside Documents ( consents, HIPAA info, living wills and health care proxies, home b/p and glucose results, etc. ) and Outside Documents ( consults, xray reports, etc) into Charts Paperless Continued Integrated Electronic Ordering Fully integrated with lab ( POL and Outside Labs ) Message Documentation Phone notes Refill requests Seamless communication between staff, providers Faxes into/out of EHR Kiosk Registration Auto insert into PMS-clean data Prepay co-pays 2
Converting to the EHR The How To Pick The Right System ACP Practice Management Center Visit Install Sites EHR Adoption Roadmap at www.acponline.org/pmc/ehr.htm Training Make someone THE BOSS Develop workflows before going Live-talk to install sites Formal outside of patient care time Practice Software Spend Time! At MHMG, we gave doctors months with formal training classes starting in April-July Converting to the EHR Preload Pick Most Active Patients Frequent Flyers with multiple problems and medications Those patients scheduled for 1 st 2 live weeks Preload the most common diagnosis, medications and orders College students, PT help, etc Cannot pre-convert the entire chart Going Live Going Live Delegate who does what Make a decision and stick with it-no exceptions unless wrong! Stager doctors Cut office time in half for 1-2 weeks for live docs Get coverage for doctor s over-flow patients! Pre-load those that were not done for tomorrow before going home Do it during slow season End of June thru early September Cut down vacation time Agenda The Pitfalls Doing it Both Ways Eliminate dual processes as much as possible Not Enough Training Do dry runs Too Many Patients Poor Delegation Inadequate Workflows Poor Communication 3
Agenda Benefits of Paperless More Income and Less Time Efficiency in documentation re- E/M coding Increase level of codes appropriately Decrease liability of insurance audits Quick refills Quick DRUG interaction info Automated preventative reminders Automated recalls Less wasted time looking for charts, papers etc 4
Benefits of Paperless Overhead Medical Economics Nov. 7, 2003 Less Expenses Staff File personal Phone personal Lab personal Billing personal Overhead Getting Worse Medical Economics Jan. 21,2005 Expense as a Percentage of Gross Income Medical Economics Nov. 7, 2003 30% 25% 20% 15% 10% 5% 0% Payroll Office Space Malpractice Supplies Lab Staff Reductions and Reassignment Less Filing Less Registration Kiosks On-line updates Less Phone Staff On-line appointments, refills, referrals Patient Internet Data Centers for Medicare and Medicaid Services 1999 21% of Medicare patients go on-line for medical information Harris Interactive Poll April 2003 80% of all patients use the Internet to view and search medical information. When on-line, they go to an average of 5 web-sites for information Kaiser Family Foundation Study 2005 66% of patients 50-64 go on-line for health info 33% of patients 65 and older used the Internet 5
Phone Message Scheduling Phone Message Patient Scheduling Paper Chart EHR Telephone On-Line Secretary Writes Message on Pad Staff Locates Chart Attaches Note Doctor Responds And Documents Secretary Types Message in Chart Doctor Responds And Documents Patient Calls, Secretary Discusses Limited Options All Phone Lines Ringing Staff Stressed Patient Feels Rushed No one is Happy Patient Goes On-Line 24/7 To Make, Cancel, And View Appts Email Reminders Chart is Filed Away Confirmations Refills Benefits of Paperless Secretary Writes Message for Rx Paper Office Staff Obtains Chart Attaches Message Refills On-Line Patient Clicks Mx, #Pills and Refills Doctors Retrieves Info, Writes Rx Checks Interactions? Chart is Filed Away Documentation? Doctor Reviews Checks Interactions Routes Appropriately Ease of Following Practice Guidelines Measure QA Improved Disease Management Better Pay? Obtain Medical Records Remotely Improved Care On-Call Less Liability Conclusion There Is A Way To Make A Living Modernize Invest time and money now for your future Approach changes in practice as you would a sick patient Deductive reasoning to understand the differential diagnosis Make a reasonable game plan and stick with it Change one variable at a time There Is Light At The End of The Tunnel Increase office efficiency Increase revenue Decrease overhead Increase patient satisfaction 6