Discover the wide array of benefits and cost savings that accrued when a Charlotte, N.C. cardiology clinic implemented electronic medical records.

If you don’t think electronic medical records can save money and improve performance for your practice, talk to Stephen McAdams, MD.

McAdams, CEO of Mid-Carolina Cardiology in Charlotte, N.C., convinced all 25 physicians in the practice to use electronic medical records (EMR) and says the results are impressive. EMR raised revenue, lowered overhead costs and improved quality and patient satisfaction.

He had previous experience with an EMR and when he interviewed for the CEO position in 1999, he wound up giving a PowerPoint presentation to every doctor saying, “This is where your practice is. This is what I think I can do for you.”

The first year of EMR, “we raised revenue by 35 percent. Our overhead went from 62 percent to 46 percent because the practice became more efficient in every aspect from checking in patients to seating them in the rooms,” McAdams says.

The EMR system, developed by Gateway Electronic Medical Management Systems, tracks all the patients’ movements: when they check in, how long they sit in the waiting room, when they go into the exam room, how long they are with the doctor, the total time of the visit. Mid-Carolina sees about 45,000 office patients each year.

“When physicians see how their data compares with others, it inspires all of them to be more efficient,’ McAdams says. The system is integrated with the billing system, scheduling, prescription writing, doctor visits and hospital encounters.

Benefits of EMR

McAdams says EMR brings many benefits to his group including:

Proper billing

With EMR, the doctors don’t have to remember all the ICD9 codes to do the billing, he says. They use a pointer to click on terms they know–atrial fibrillationchronic, angina-stable, hyperlipidemia–and that links automatically with the ICD9 codes so the bill is generated and the level of service is actually suggested by the computer.

“The screen says, ‘It looks like you did a level 3. If you think you did a level 4, you better go back and find out what you missed,”‘ McAdams explains. “It is always calculating where you are in the medical decision-making process. When the doc is done and the patient is escorted out to the front, the super bill is in the computer.”

Momentus’ comprehensive, resident-centric Electronic Medical Record can help improve quality of care, survey compliance, and reimbursement levels. Electronic MAR and TAR integrate with the care plan and clinical pathway. The EMR System tracks clinical outcomes and best practices, and includes 80+ assessments for data collection and documentation that integrates with the MDS.

Paperless charting, touch-screen ADL worksheets, wireless medication charting, shift reports, and audits are built into the system. Dietary Management, Business Analytics, and Microsoft Great Plains Financials are other products offered. Momentus provides complete project management services, and skilled instructors provide on-site training. Conversion integration and customization services are available to ensure satisfaction. Momentus has the flexibility, both in price and performance, to allow facilities to choose the system that fulfills their information-processing requirements.

Most security concerns related to EMR systems originate from within the physician practice. Physicians’ main concerns are information security, confidentiality and data ownership. Overall, it is reliance on technology to maintain patient records that physicians often consider suspect.

Here are the most important security features that physician practices should consider when they evaluate EMR systems.

Evaluate user authentication. Who is an authorized user? Does the system utilize user IDs and passwords, or possibly biometrics? Who assigns user IDs? Does the system discourage sharing of user IDs? Generally, physician practices address this with an administrator who establishes users and removes them from the system.

Establish specific user authorization. What is each user authorized to see? Make sure the system offers role-based access. Patient information must be compartmentalized so that it is used productively and properly. For example, patient data that the physician may access is markedly different than patient data that the receptionist should access. The practice administrator usually assigns access levels.

Verify EMR access logs. HIPAA legislation requires that physicians can provide patients with a list of who has seen their chart and which parts of their chart have been viewed. A key feature of any EMR system is the ability to provide this data to patients once requested. This capability should be a natural byproduct of any credible EMR system today.

Information integrity. Develop a strategy for the constant care and feeding of the EMR system, which requires much more than regular system backups. It is critical that these updates are promptly and properly installed, and that it is still possible to access backed-up, older patient data after new versions are in place.

Information security. Is the EMR information secure? Does security travel with the data? Is data encrypted as it travels from the server to the user, particularly across wireless networks? Make sure data is encrypted and that the encryption process is built into the architecture of the product itself; not doing so may greatly slow down the transmission of information.

Allina Hospitals & Clinics has launched one of the largest electronic medical record implementations in the US at Buffalo Hospital. The Hospital is the first Allina hospital to move away from paper processes and begin using an electronic medical record system that will ultimately be shared by all of Allina’s seventy-six sites, including 11 hospitals and sixty-five clinics. Four Allina Medical Clinic sites in Annandale, Buffalo, Cokato and Litchfield transitioned earlier this month.

“Transitioning to an electronic medical record system is a top priority for Allina because it provides our doctors and employees with the necessary tools to enhance the quality and safety of the medical care we deliver to patients,” says Dick Pettingill, President and CEO of Allina Hospitals & Clinics.

Allina says that the number of sites and the sharing of patient records among those sites make this implementation one of the largest, most integrated electronic medical record systems in the country. When the implementation is completed in the next four years, all of Allina’s clinics and hospitals will document a patient’s care in one shared electronic medical record, which provides a more complete picture of a patient’s medical history at Allina. This translates into less hassle for patients in transferring their medical information from one Allina caregiver to another and/or repeating the same information multiple times. Doctors and caregivers will be able to reference all of a patient’s vital statistics, test results, medications, allergies and prior health conditions - regardless of where the information was collected within the Allina system.

“Understanding the full scope of a patient’s current and past care helps doctors make the best recommendation for a condition or illness,” says Andrew Burgdorf, a family physician at Allina Medical Clinic - Buffalo and at Buffalo Hospital. “Often times, patients don’t remember or can’t provide details of the care they have received. With one patient record, Allina caregivers are able to view information about a patient’s treatment at Allina, confer with each other on patient care, and review a history of test and lab results.”

With Allina’s electronic medical record system, caregivers have:

* Timely access to medical information. A patient’s complete medical history can be viewed with a few clicks of the computer mouse by doctors and caregivers with security privileges, providing immediate, easy access to patient information.

Baylor Health Care System has selected DocuData Solutions to manage the digitization of patient medical records. With electronic patient medical records, Baylor hope to be able to improve efficiencies, which it believes should lead to reduced operational costs and, ultimately, better care for patients.

Baylor is implementing improved medical records processes across its system of hospitals. As part of that process, Baylor is working toward a goal of total patient record digitization. After extensive research, Baylor says that it “recognized that DocuData offered the greatest efficiencies, making it the ideal selection as preferred imaging vendor”.

“The first step in moving toward electronic patient records is implementing medical record imaging,” said Vice President at Baylor University Medical Center, Donna Bowers. “Outsourcing this to DocuData as our preferred vendor will give us greater flexibility vs. keeping it in house.”

Cost Reduction

Medical record imaging is the process of taking the paper medical records and scanning them electronically to produce a digitized image that can be stored on a computer. Once the record is in electronic image format, it can be transmitted and accessed quickly and easily throughout an organization, thus reducing costs.

“Creating electronic images and integrating them into existing and/or new business processes has the potential to dramatically streamline Baylor’s handling of medical records,” said DocuData Solutions President Brian Rathe. “Our ability to cost-effectively and efficiently implement this process made us a natural fit for Baylor.”

“I have worked extensively with DocuData in the past, and their ability to understand our business as well as their quality, attention to detail, and high level of customer service made them the best choice for Baylor,” said Director of Health Information Management at Baylor Garland and Chair of the Vendor Selection Committee Suma Chacko.

“This selection underscores DocuData’s standing as the premier medical records imaging provider in the Southwest,” Rathe added.

The contract will run through the end of 2007 with the option for another two-year extension that would run through the end of 2009.

The American Medical Informatics Association (AMIA) has announced the program details of its conference Practical Strategies for Implementing Electronic Health Records, that will take place on April 28-29, 2004 in Washington, DC. The conference has been developed to assist healthcare executives, senior managers and teams who are or will soon be implementing electronic heath record (EHR) systems. The two-day conference is being co-sponsored by several major health information management and technology associations, including the American Health Information Management Association (AHIMA), the College of Healthcare Information Management Executives (CHIME), the eHealth Initiative (eHI), the Healthcare Information and Management Systems Society (HIMSS) and the National Alliance for Health Information Technology. Regular registration rates for the meeting begin at $545 (early bird) for any member of AMIA or any co-sponsoring organization.

Presentations by national experts on EHR implementation will focus on such topics as the specifics of gaining executive buy-in, cost/benefit considerations, and designing and executing successful implementation plans. The keynote speaker will be Herbert Pardes, President and CEO of New York Presbyterian Hospitals. In addition to presentations from national experts who have successfully implemented EHR systems, the Congress will feature interactive small group sessions with the experts and other opportunities for networking.

The Chair for “Practical Strategies for Implementing Electronic Health Records” is Paul Tang, Chief Medical Information Officer at Palo Alto Medical Foundation, Palo Alto, California. Dr. Tang is a past recipient of the Nicholas E. Davies Award for Excellence in Computer-based Patient Record Implementation, and is Chair of the Institute of Medicine’s Committee on Data Standards for Patient Safety, which recently issued the report Key Capabilities of an Electronic Health Record System. Co-chairs of the Program Committee are John Glaser, Vice President and Chief Information Officer at Partners Healthcare, Boston, MA, and J. Marc Overhage, Associate Professor of Medicine, Indiana University School of Medicine and Senior Investigator, Regenstrief Institute, Indianapolis, IN.

The U.S. Department of Justice may soon be reading through medical records to try to make its case that the recently enacted “Partial Birth Abortion Ban Act of 2003″ should stand. A federal judge in Manhattan recently ruled that the department could subpoena patient medical records for physicians involved in a New York court case to try to determine if the banned procedure was medically necessary. A similar request was shot down by a judge in Chicago. However, that ruling is being appealed. The Justice Department request has sparked concerns about medical privacy. “To assert that the government has an unfettered right to root around in our private medical records is beyond appalling, and brings to mind the basic question in the debate over a woman’s right to choose–who decides,” said Kate Michelman, president of NARAL Pro-Choice America. But the Justice Department says the medical records it seeks will not contain identifying information about patients.

In this age of hurried health care, you’ll probably spend more time in the waiting room than in the examining room. But we can’t afford to get short shrift when it comes to our well-being. So we posed this question to several physicians: What can we do to get the most out of even the briefest of doctor’s visits? Here’s what they told us:

Sweat the small stuff

Doctors say they base the vast majority of their diagnoses on what their patients tell them. But if you’re complaining about, say, an irregular period and you can’t remember when it started, you make it hard for your doctor to figure out what’s wrong, says Andrea N. Price, M.D., an ob-gyn at the Women’s Health Alliance of New Jersey. To give your doctor a better understanding of what ails you, set aside a diary just for your health and record when you feel off, what your symptoms seem to be and what’s going on in your life at the time. Then bring it with you to your appointment.

Be your own expert

Doctors admit that well-informed patients instantly get more respect. “Doing your research beforehand alerts your doctor that you are knowledgeable and there are expectations to be met,” says Tina Raine, M.D., associate professor of obstetrics and gynecology at the University of California, San Francisco. The Internet is the best place to start. While there is a lot of bunk to avoid, government health sites such as the National Institutes of Health (nih.org), and home pages for medical schools and medical associations are loaded with useful information. Sift through them for info on screenings recommended for women in your age group. You can also do research on any symptoms you might have, as long as you don’t try to diagnose yourself, Price says.

Tell the truth–the whole truth

“Sometimes patients are concerned about how they’re going to be perceived and don’t disclose as much as they should,” says Evelyn Lewis, M.D., medical and research specialist at Pfizer, Inc. Being up-front with your doctor can be tough when it comes to your sexual history or lifestyle choices you’d rather keep to yourself. But most doctors aren’t judging you; they just need to know if anything is jeopardizing your health, so ‘fess up.

SanDisk Corporation (Nasdaq: SNDK) today announced its participation in a demonstration that shows the compatibility and interoperability of the Continuity of Care Record (CCR) on a SanDisk Cruzer Mini USB flash drive. The CCR standard is aimed at creating a transportable set of basic health information that contains the most relevant data about a patient’s condition at a particular point in time. The demonstration was conducted at TEPR ‘04 (Towards an Electronic Patient Record), the 20th annual conference and exhibition of the Medical Records Institute.

“As the use of portable electronic patient records becomes more popular, we envision patients carrying their medical records as two files,” said Ed Cuellar, director of marketing at SanDisk. “One file would be non-secure and would contain critical information that might be needed during an emergency, when the patient may be unconscious and unable to provide the password to his complete record. This non-secure data would consist of critical information such as name, insurance carrier, emergency contact, blood type, allergies and major medical conditions such as diabetes. The second file would be secure and might contain the patient’s entire medical history, including imaging data such as radiology results, X-rays, and MRI and CAT scans,” he added.

“Today, federal law requires physicians to provide a patient with his or her medical record, upon request,” said Cuellar. “Having the record already in an electronic format and having a portable flash drive makes this process practical and easy.” USB flash drives are small enough to carry on a key chain and have sufficient capacity to store considerable amounts of personal medical records. “SanDisk has gained substantial experience from our P-Tag program with the U.S. military in the past three years, and we believe that we can put that experience to good use in this portable medical records application,” he said.

Electronic medical records (EMRs) offer many advantages. However, there are also risks involved with adopting a full commercial EMR. These include high cost, the disruption of clinic routines, and poor or no vendor support. We created and implemented a partial, or miniature EMR (mini EMR) based on Microsoft Access 97 (Microsoft Corporation; Redmond, Wash). This program serves as an electronic front sheet for the patient chart that records International Classification of Diseases–9th revision codes and chronic medications and allergies, and provides reminders for prevention, procedures. The mini EMR has been inexpensive, adaptable, easy to maintain, and very well accepted, and it has caused little interruption of our clinical activities. We believe the program can serve as a bridge to a future commercial EMR once that market has matured.

For several years our residency program had been considering the purchase of an electronic medical-record (EMR). We had seen demonstrations of the products and were aware that a few practices in our area were using full EMRs. We knew of their many advantages, as delineated in several recent articles. (1-3)

Our faculty had 3 major concerns about the purchase of an EMR. The first was price. The cost of implementation cited in the literature varies widely; one source estimates $15,000 per full-time physician. (1) There is disagreement as to whether the operating expenses of paperless EMR systems are less than traditional paper systems. (4) The savings in dictation and filing are often offset by fees for service agreements and technical support. Thus, it seemed unlikely that an EMR would significantly decrease our operating costs in the immediate future.