Spotlight on Hospital Information Systems May 25, 2010
Featured Article
Practice sees return on EHR with help from consultant

Other EHR benefits include improved cash flow, with claims and bills processed more quickly and tracked more closely.

A year ago, Dr. Jack Cappitelli looked at the invoice his electronic health records vendor submitted for time stuck in traffic on New York's Tappan Zee Bridge. He was beginning to feel a little stuck himself.

The process of implementing an electronic health records system into his practice was taking too long and costing too much. After six months, just three of his 12 physician partners at New Jersey Associates in Medicine were using the system, and the finish line for the rest was nowhere in sight.

Cappitelli and the other doctors at the multi-specialty practice in northern New Jersey knew they had a good product. They had done nearly two years of research before selecting their particular EHR system and were committing nearly half a million dollars to implement it. Most of that potential, however, was yet to be realized as they endured what seemed like an endless loop of software modifications, mounting training expenses and growing delays.

"We bought a Porsche but we were using it like a Hyundai," says Cappitelli, a doctor of internal medicine. "I was afraid we'd get stuck with a failed system and have all the doctors still charting on paper."

It was then that Cappitelli realized they needed help - someone to take control of the process, someone to make the vendor and the product bend to the needs of the practice, rather than the other way around. They called in Health Informatics Consulting, a New Jersey firm that helps doctors, hospitals and other healthcare organizations select and implement EHR and practice management systems.

The need for extra help is something many physicians and practices don't anticipate when planning and budgeting for an EHR implementation, says Stevie Davidson, president and CEO of Health Informatics Consulting. The price of an EHR system is daunting enough that many doctors hope to rely solely on the setup and training services the software vendors provide.

While vendors certainly know their products, they rarely get to know the practice as well as they should, says Davidson, who also serves on New Jersey's Health Information Technology Commission, a body working to facilitate adoption of EHR by doctors.

Cappitelli says a good EHR advisor acts as the physician's advocate, and can bridge the gap between the vendor's technical expertise and the real-world needs of the practice. In short, they help doctors make the most of their EHR investment.

Health Informatics Consulting began its task at New Jersey Associates in Medicine by conducting a full operational analysis. The company spoke to the physician partners, medical assistants, billing and collection staff, lab staff - everyone whose work touched the EHR system in some way. The company assessed what training people had already received, what they still needed to obtain to perform their jobs effectively, and the need for any reinforcement training.

The firm followed this with a technical competency assessment, evaluating the basic computer skills of both physicians and staff - more than 60 people in all - and arranging special training for those who required it.

A detailed matrix then mapped out each area of the multi-specialty practice, each feature and module of the EHR system, and the roles and responsibilities of doctors and staff in relation to them.

As Health Informatics Consulting gathered this data, it also looked at the overall work flow of the busy practice, which sees roughly 900 patients a week. It watched what happens from the time a patient checks in until he or she leaves, observing typical scenarios for events like ordering lab tests, handling waiting lists, performing hospital rounds, and more. The firm noted when those practices would have to be modified to work best in an electronic environment, as well as opportunities for the office to operate more efficiently.

All of this research, conducted over the first three to four weeks, was gathered in a comprehensive - and lengthy - report. Cappitelli says he laughed when Davidson first presented it.

"I thought: We are never going to get all this done," he recalls. "But it wasn't as bad as it first looked. We went though the checklist and took them one at a time."

With that research as a foundation, the EHR rollout began in earnest. In the months to follow, Davidson's firm worked closely with the vendor, the physicians and the practice manager to get the system up and running in every department, and get everyone comfortable with it.

One year after the process began, Davidson and Cappitelli say New Jersey Associates in Medicine is seeing a return on its EHR investment in the form of improved staff efficiency, cost savings and improved physician communication leading to even better patient care.

Gone are the days when patient medical records traveled by dumbwaiter to the different floors of the three-story medical practice.

Gone are the expensive transcription services for doctors - dictated notes - once as high as $250,000 a year at Cappitelli's practice.

Better still is the way doctors can more easily share information. With different specialists on staff, it's not unusual for patients to see more than one physician on the same day for separate but related conditions. In the past, these doctors might have seen these patients without knowing anything about their other visits. With EHR, this information is readily at hand. A doctor, for example, can now check that the medication she was about to prescribe won't interfere with the prescription her partner upstairs had written moments earlier.

Other EHR benefits include improved cash flow, with claims and bills processed more quickly and tracked more closely.

Having an EHR system also puts New Jersey Associates in Medicine in a stronger negotiating position with payers, notes Cappitelli, as doctors demonstrate that they are operating more efficiently. They are also saving on their malpractice insurance, as carriers increasingly offer discounts to doctors using EHR.

"We were efficient as a practice before EHR," says Cappitelli. "But I know the office is running more smoothly than ever and it's only going to get better."

Cappitelli and Davidson offer the following advice to doctors, practice managers and healthcare office IT pros preparing for EHR: Take charge of the process.

"The most important thing I've learned is that you are in control of the situation," Davidson says. "Don't let the software companies and trainers drive you. You have to drive them."

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