Managing Your Practice
With New Technology

Pave the Way to Efficiencies

By Susanna Donato
Susanna Donato is a writer for Physicians Practice

You can buy the best software in the world, but unless you change how you manage your practice with electronic tools, you’ll spend more time than before on everyday tasks. The key is redesigning the practice and staff to fit the new work flow. When you do, your workdays will become more efficient.

What technology can do
“There’s no other industry in our country that keeps its primary database in manila folders,” said Mark Johnson, president of MediNetwork, a Dallas-based medical group-practice consulting firm that specializes in practice management systems design and implementation. “Somewhere between 72 percent and 93 percent of all medical information is still in a manila folder.”

Practice management software manages scheduling, appointment reminders, claims submission and other routine tasks with a click of the mouse. Electronic Medical Records (EMRs) bring medical information out of that manila folder and into a single file. No copies of insurance cards, lab results, exam notes or other slips of paper get lost; no chart gets waylaid in the bottom of a hard-working on-call physician’s briefcase.

“[Before the EMR] we’d be pulling probably a hundred charts a day for the triage nurse. Now, it’s all right there. The triage nurse can view a chart while she’s on the phone with a patient, instead of asking us to pull the chart,” said Sherry Young, the health information management director for Page-Campbell Cardiology in Nashville, which has used an EMR for nearly eight years. “As far as quality of care, it was good before, but I must say it has improved.”

What technology can’t do
Many practices tell tales of technology eliminating rental fees for extra chart-storage space, letting transcriptionists dwindle away and reducing everything from office space to administrative staff.

But just as they save money, technology tools also cost money — a bundle of it. EMR implementation initially costs between $15,000 and $50,000 per physician, according to the California HealthCare Foundation (CHCF), an organization focusing on the way health care is delivered and helping consumers to make informed health care and coverage decisions. For that reason, fewer than 25 percent of U.S. physician practices have made the move to an EMR.

Still, EMRs and other technology are the wave of the future. When and if you take the leap, make the most of your sizable investment by designing office processes to best use the technology.

“What’s important is to look at your work flow and at the way you see patients in your own particular office because everyone does it differently,” said Jim Morrow, M.D., of North Fulton Family Medicine in Atlanta. “Then, you’ve got to find an EMR that lets you see patients, from a clinical standpoint, in the same way you do currently — but one that’s also customizable enough to let you improve work flow. For instance, you need one that lets you get rid of dictation and transcription, eliminate the hours spent hunting for charts and decrease the confusion around the billing process by using an automatic billing interface.”

Health care consultant Debi Croes, of the Croes-Oliva Group in Burlington, Mass., agrees with Morrow. “People think they’re going to automate their work,” she said. “But, in fact, they’re going to change the way they work.”

Using technology right
Making the most of technology means thinking through practice policies.

“Assign someone to manage the project who understands the practice, understands the technology and understands the present work flow,” Croes said. For instance, she said, if today a nurse reviews lab results, but the EMR will send those results directly to the physician, then one step of the nurse’s job is gone.

“You’ve got to redesign that work flow before the EMR is implemented,” Croes advised. “That means taking time to build templates, so the same kind of visits are handled the same way. It’s a big task, and you’ve got to give it to one person, not a committee.”

Remember, Croes said, that a busy practice administrator might not be the right person to take on this enormous task. Carefully think through your choice for an implementation manager or consider involving a consultant.

“In some cases, a handful of physicians use the EMR, and the rest still use paper,” added MediNetwork’s Johnson. “That doesn’t help — then the information is in two places.”

Young’s practice in Nashville shared that experience. “It took a couple of years before everybody completely used it,” she said. “Now ... every physician has started using some kind of encounter form or template.”

Young also had to decide when to cut staff off from paper charts. “We stopped making paper charts in 1998, but up until last year, we were still pulling charts,” she said. “When we made the decision to stop, we had very few complaints.”

Changing work flows
CHCF conducted a study, “Electronic Medical Records: Lessons from Small Physician Practices,” to see how practices had reorganized work flows to successfully implement EMRs. The study reported that, among other things, offices changed the tasks each staff member performed. For instance, receptionists and nurses who began spending less time tracking down charts could spend more time talking with patients and entering data into electronic forms before patients entered exam rooms. This reduced the time physicians needed to document visits.

However, one family physician interviewed for the study cited the way the EMR had changed physicians’ time commitments when it first came into use. This doctor said fully adapting the EMR took about three years. The problem is that for most investments reaching into five and six figures, practices can’t stomach a learning curve that long.

“A three-year learning curve is unacceptable,” said Johnson. “And the problem with a lot of commercially available products is that it can take eight or 10 minutes to document a three-minute encounter. Is it best to spend 11 minutes on an encounter, or is it best to hand it off and spend that additional eight minutes to generate revenue?”

Don’t buy until …
Practices can take small steps to prepare their practice for an EMR or other electronic solution, without jumping all the way in. First, said Johnson, make sure everyone who will work with a computer screen has adequate familiarity with computers — even general Windows navigation, how to work with a mouse, etc. Then, try a small task, such as documenting electronic superbills or charge tickets.

Staff morale is another issue that should be discussed ahead of time, said Morrow. “The biggest thing that we found was that first, you have to have a go-to guy — someone who is the cheerleader for the group. That person can keep the excitement level and energy level up through what can be a fairly stressful time of decision-making and spending a lot of money.”

Numerous studies support Morrow’s advice. Johnson also agrees with Morrow.

“You need an advocate within the practice that will take the ball and charge through the volume of configuration and setup required to make this work,” said Johnson. “It’s an all-or-nothing proposition to really exploit an EMR properly.”

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