For its success adopting and integrating an electronic medical record (EMR) tying together numerous scattered offices, Cardiology Consultants of Philadelphia (CCP) was honored at this year’s Healthcare Information and Management Systems Society (HIMSS) conference in Chicago April 4 as a recipient of the society’s Ambulatory Care Davies Award of Excellence.
Recipients of the award demonstrate how an EMR is essential to improving a practice’s daily operations, including workflow and finances, while supporting clinicians’ mission of enhancing patient safety and providing quality care. Scott E. Hessen, M.D, chief medical information officer for CCP, spoke at HIMSS and offered advice to other providers who are transitioning to an EMR system.
He said CCP had its work cut out for it when it decided to transition to a single electronic medical record (EMR) system. It is the second largest cardiology practice in the country with 21 locations extending over four counties. It has 85 physicians on staff at 22 hospitals and interfaces with three university health systems. The group had to unify 21 separate offices, 13 imaging centers and an ambulatory cath lab. They set out in 2005 to create a unified EMR system and completed it in 2007. Dr. Hessen said they started by making major improvements to their IT infrastructure, installing a fiber optic network, adding IT staff, and spending a year customizing the cardiac practice EMR.
Dr. Hessen said it is very important to have a comprehensive plan to follow to ensure a clear path is followed.
“We had a plan for deployment, we had a plan for infrastructure and a plan for training,” he said.
When deciding to adopt an EMR, CCP’s Board of Directors suggested some of the goals for the new system should include improved patient care, reduced filing and transcription costs, reduced malpractice exposure and costs, and analysis of individual and group practice patterns. These benefits have been realized since CCP completed its EMR implementation.
In formulating these plans project leaders need to have a thorough understanding of the workflows involved and how they will change when using the new system.
A big help in organizing a transition to an EMR system is to speak with other providers who already underwent the process. Dr. Hessen said they will provide a lot of insight into the problems you are likely to encounter.
“When experienced people talk you should listen because they have been through it,” he said.
Cardiology Consultants used an organized approach, bringing the system online at one facility at a time, and using the people from the trained facilities to help mentor the others who were just beginning the transition.
Dr. Hessen said using an EMR for the first time will help shed light on problems that had previously gone unnoticed.
“We had a lot of things we found living under rocks when we went live with our EMR,” he said.
A common problem they found was staff still using sticky notes to communicate with doctors, which avoided communications in the EMR, leaving some information out of the patients’ records. They also found some legacy computer systems they planned to interface with the new EMR could not be easily connected.
Another issue they found were hold-outs who did not want to adopt the new technology right away and continued working as they had previously with paper documents.
“Never allow stragglers,” Dr. Hessen said. “It’s just a very bad strategy. Just flip the switch and everyone goes live.”
He said hold-outs slow down the adoption process and create twice as much work for those responsible for managing the records, forcing them to enter information twice. He said that defeats the efficiencies an EMR is supposed to offer.
CCP said the EMR system delivered the efficiencies the doctors and staff expected.
“We found substantial return on investment,” Dr. Hessen said.
Part of that savings has just been from eliminating paper usage and cutting outgoing mail costs by sending information using fax servers instead of envelopes and postal meters.
The system was customized and has several features to act as reminders for patients and doctors. One example is the system will offer tips doctors should recommend to patients with specific conditions. Another prompts clinicians to recommend to patients who are listed as smokers that they quit smoking. Another prompt programmed into the system recommends to clinicians that ECGs should be given during every office visit for patients with specific conditions.
The system also helps with compliance with industry guidelines, such as asking patients about compliance with aspirin/antiplatelet therapies. Dr. Hessen said as an example 80 percent of patients may show up in the system as complying with the therapy, but 20 percent will be unaccounted for show be listed as noncompliant. He said they altered the program to ask why the patient is noncompliant and to enter the information, because in many circumstances there is a good medical reason why they are not taking the medication. He said this helps account for 100 percent of patient compliance.
Follow up since going on line with the system includes speaking with staff on a regular basis to see if the system can be tweaked to help generate more efficiencies.
Looking ahead, CCP plans to investigate a picture archiving and communication system (PACS) solution for digital image storage and manipulations of images, as well as a secured e-mail messaging solution.