May 2009 | | Issue 5
Health Management Technology

EHR Enables Orthopedic Practice to Grow 25 Percent Annually

By David Klebonis

Before implementing an electronic health record (EHR) in mid-2006, the Center for Bone and Surgery of the Palm Beaches in West Palm Beach, Fla., was composed of nine orthopedic surgeons who saw about 300 patients daily at four locations. Since then, the EHR has become an indispensable tool in helping increase patient encounters by 25 percent annually while holding down administrative and clinical support cost increases to just 5 percent a year. From our initial research we expected the EHR to enhance quality of care and efficiency and reduce labor costs and we achieved all these benefits except labor savings. However, that's because we opted to re-deploy more than half of our 10 full-time medical records clerks and utilize existing clinical employees to increase patient visit volume by up to 25 percent per physician by using physician assistants.

Turbo Charging Growth
Our EHR implementation drove our patient encounters from 76,800 annually to 108,000 annually over a 2-year period. At the same time, productivity gains resulting from the EHR allowed us to better offset or control rising expenses. For instance, the EHR's electronic prescription writer, laboratory ordering and clinical tasking features saved our physicians one to two minutes per patient encounter and up to one hour per half day clinic (35 to 50 patients), which allowed them to easily accommodate a higher patient load while working normal schedules. Higher efficiency from our 120 clinical support staff, and the fact that the EHR permits multiple people to access the same chart simultaneously from anywhere, made it possible for the Center for Bone and Joint to add physician assistants without increasing administrative staffing. That would not have been possible in a paper environment where charts were so voluminous employees had to carry them between offices in suitcases.

We also selected our EHR because of its flexibility and scalability. For instance, we can open an office within 30 days of signing a lease because we can quickly and seamlessly set up the EHR (and PM) system without adding computer servers. This has enabled us to fully integrate a new office and to ensure immediate access to all patient records at a new location from day one. Before EHR, it took us at least 120 days to open a new location. Now, all we need are additional user licenses and a high-speed wide-area connection to be up and running. We also can quickly shift clinical and administrative staff from site to site when a disaster, such as a hurricane, shuts down a single office - a key consideration in Florida.

We estimate that we recouped our EHR investment within one year. Furthermore, we expect to realize even greater savings and efficiencies over the next two years when we replace our existing practice management (PM) software with an integrated EHR/PM solution.

Minimizing Disruption
When the Center for Bone and Joint Surgery decided to transition from paper charts to electronic records in late 2005, we chose to continue using our existing PM software to minimize disruption. After evaluating vendors, we purchased an EHR from the same company that supplied our PM system partly because the vendor offered a single-database, fully integrated solution with PM and EHR modules that could be installed separately. That accommodated our budget and desire to phase-in the solution.

To eliminate on-site storage of paper charts, we scanned our 50,000 records in 2006. During this period, each physician was trained and went live using the system one at a time for two weeks. After that five-month training period, our physicians were using the EHR exclusively. Although some physicians initially resisted, once they saw that the EHR truly helped them provide better, safer and more efficient care, they became enthusiastic users.

Further Gains to Come
Over the next two years, we expect the EHR to become even more valuable than it is today. Here's why:

  • A 500 square-foot area that was previously medical records storage is being converted into revenue-generating space: either physical therapy, an extremity MRI, or sub-leased administrative space to a third party.
  • With the overhaul of our PM system to an integrated EHR/PM, workflows, reporting and patient interactions via the internet will improve, which will further enhance business efficiencies as well as clinical and business decision-making.
  • While physicians are still dictating progress notes today, all will eventually document electronically via EHR as they gain confidence that they can maintain or improve their current productivity level. This will generate a $50,000 monthly savings for the practice.
  • Although the practice writes some prescriptions electronically, many orders are for controlled substances that, by law, cannot be prescribed electronically. A potential boon to improving this workflow, The Drug Enforcement Administration has proposed lifting the ban on e-prescribing of controlled substances.
  • The EHR facilitates physician recruitment because it demonstrates our commitment to providing surgeons the tools and information they need to do their jobs better.

Many practices consider implementing an EHR to grow their practice, but they may not realize the full range of benefits it can provide. I am 100 percent confident that without our EHR, we would never have achieved the ongoing expansion of our core practice or our move into pain management and anti-aging - new service areas with tremendous growth potential. Early on, we would have collapsed under the associated administrative demands instead of thriving as a dynamic, highly successful, patient-centered practice.

David Klebonis is executive manager, Center for Bone and Joint Surgery of the Palm Beaches in Wellington, Fla. Contact him at