Getting Off the Paper Trail

Lakeview Family Health Care in Lake Havasu City, Ariz., is a family practice in the true sense of the word. Pediatrician Lorraine Byrd and her daughter, family practitioner Kelli Ward, opened the practice in August 1999, and retained Byrd's husband (and Ward's stepfather), Richard Byrd, as practice manager.

Beginning in 1993, Lorraine Byrd practiced solo in Rockwood, Tenn. A latecomer to the profession -- she started medical school at age 42 -- Byrd was willing to start over because she and Ward had always dreamed of practicing together. Today, their practice thrives on the partners' mother-daughter relationship, as well as their transition toward becoming a paperless office.

"It seemed to me that if we were going to start a brand-new medical practice, we should take advantage of technology," says Ward, who is in practice for the first time. While a second-year resident at Garden City Osteopathic Hospital in Garden City, Mich., she did considerable research on electronic medical records (EMR). Making the conversion to an electronic system seemed like a logical move. "It was a lot less complicated than if we had thousands of patients and had to convert their records."

In the beginning, the practice retained paper charts. Once the EMR system proved to be dependable, the paper charts were shredded. Although the idea of using EMR made sense to Byrd, it was somewhat intimidating to her. "Computers were a new concept to me after practicing for seven years with traditional charts," Byrd says. "But I've really enjoyed the transfer to computers and I'm amazed at how dependent I am on them now."

Richard Byrd, who says he had little prior computer knowledge, learned the system by trial and error. Today, he knows every nuance of the EMR, and, with minimal help from a computer consultant, keeps the office running like clockwork. The medical records of more than 4,000 patients are accessible around the office by four laptop and 19 desktop computers.

Smoother processes

According to Ward, the practice's EMR program is easy to use. "I wanted a program that would resemble a paper chart as much as possible," she says. "It lets you see a whole chart on one screen."

Having the charts accessible by computer has improved patient flow. A check-in clerk enters patients' demographic information and scans insurance cards into their records. For each patient visit, she produces a tracking sheet that follows the patient throughout his or her visit.

A nurse enters patients' vital signs, histories, and symptoms directly into the EMR, which includes practice-specific templates to simplify the process. Physicians also enter the treatment level, diagnosis, and codes for each patient, and transfer the information to the tracking sheet. "Our templates and programs encourage us to document everything we need to be able to support the particular level we choose," Byrd says.

The EMR program also interfaces well with Lakeview's practice management software, and allows staff to print personalized reports. "Some programs don't allow you even to choose a font size," Ward says. "They just print generic reports. With ours, you can customize as much as you like."

With just the click of a mouse, billing information is sent from the EMR to the practice management software. Even before the patient reaches the checkout desk, the clerk's screen shows that day's billing information, plus information on all previous bills, the total amount due, the co-pay, and, in the case of a consultation, the amount of money or number of remaining visits available to the patient.

The checkout clerk reviews the patient's tracking sheet to verify the billing information, and to make sure that the diagnosis matches the procedure. The tracking sheet is retained on file, and at least once each day, the clerk sends the file to an electronic billing clearinghouse.

Materials to call their own

With an EMR, lost files are a frustration of the past. Finding specific patient information is incredibly easy.

"If a specialist calls about one of my patients that he's seeing and wants to discuss the case, I don't have to yell down the hall for the chart," Byrd says. "I just bring it up on the computer."

An EMR also makes it easy for the practice to store and retrieve reports. Currently, the Havasu Regional Medical Center, where Byrd and Ward are on staff, does not have the ability to send reports electronically. All lab reports arrive by fax or courier in paper form; once physicians have seen reports, clerks scan them into patients' charts.

Finding and printing patient education materials is also a snap. At each well-child visit, parents receive printed "anticipatory guidance" information based on the child's developmental stage. The printout includes parenting tools, nutritional information, and how-tos for determining signs of illness.

Besides offering a standard selection of patient education handouts, the program allows physicians to type in their own material and save it for repeated use, and download educational text from the Internet and various CD-ROM programs.

Ward has devised her own education system. During patient visits, she types notes -- including diagnoses, treatment plans, and follow up information -- directly into patients' charts. She then prints her notes and gives them to the patients along with their computer-printed prescriptions.

"The notes tell patients which issues we've addressed, what the plan is, and when to come back," Ward says. "A lot of patients bring the notes to their next visit and talk to me about them, or they say they were glad to have them because they couldn't remember what I'd told them."

Safe and secure

Richard Byrd makes sure that all parts of this nearly paperless practice mesh. He serves as the physicians' troubleshooter, finds missing files, studies contracts to make sure the practice is paid appropriately, and keeps both software and hardware up-to-date.

He also oversees critical backup routines. During the day, two separate but linked computers save identical data from desktops and laptops throughout the office. Each night at 10 p.m., that data is updated and saved on tape. Byrd keeps a separate backup tape for each day of the week and stores them all in a fireproof safe. Every 30 days, the entire system is written to a CD-ROM, which is kept in a safety deposit box at a nearby bank.

"Because we are in charge of peoples' medical records and they are so critical to their healthcare, we want to make sure we have them available at all times," Byrd says. "Besides all the regular backups, every morning I come in early to back up data from the previous day onto my hard drive, just in case the tape backup didn't work."

The members of the practice also find security and satisfaction working together as husband, wife, and daughter. Ward calls working with her mom "great," and the feeling is mutual.

"I'm proud of what Kelli's become and I get to watch her everyday," Lorraine Byrd says. "As a professional and as a mother, it's a wonderful thing to see my daughter giving loving, excellent care to her patients."

Janice Rosenberg can be reached at editor@physicianspractice.com.

This article originally appeared in the March/April 2002 issue of Physicians Practice.