Implementing a Do-it-Yourself EHR: 5 Tips

Electronic health records can deliver many business benefits for small medical and surgical practices, beyond compliance with the paperwork and administrative cost-reduction mandates of the Affordable Care Act and CMS' meaningful use program. An effective EHR strategy can improve efficiency and the quality of care.

However, many small practices still face challenges in moving to EHRs because of the cost of automation: including software, technical consulting, training, and updates. By taking a do-it-yourself approach, you can use the EHR mandate as an opportunity to create a practice-automation system that achieves your business goals and your compliance requirements.

My clinic did. We perform approximately 300 complex surgeries a year. Without automation, we could not keep up this pace and still deliver personalized, high-quality care. We took a DIY approach, and we're glad we did.

In the early years of our clinic, we began using a FileMaker solution to gather patient data to assess outcomes and to document each stage of our patients' medical care. By 2009, we had hired a full-time programmer and began constructing a custom-made, in-house EHR system, known as Aqueduct.

DIY Benefits

Today, Aqueduct is an advanced medical practice management system. Aqueduct stores X-rays and other imaging histories, outside medical records, appointment and surgery schedules, clinic notes, billing information, and more.

Our system captures data that flows from the initial office contact all the way through a patient

's visit in clinic, to the operating room, and postoperative visits. All the while, detailed task lists are created for staff members to keep their workload organized systematically.

Patients can go directly to the clinic website to request appointments. During an appointment, I or my physician assistant use Aqueduct to prepare and store an electronic clinic note.

After an appointment is finished, the note is automatically printed, while the billing staff process payment records and receipts. The note is also e-mailed or faxed to primary-care physicians or other involved parties via automated scripts.

While in the operating room on my iPad, I can review patient information; record critical data such as blood loss, surgery procedures, and start and stop times; and view images such as X-rays. The completed operative note is immediately accessible to staff back in the office rather than waiting days for dictation transcript.

Our system helps meet meaningful use mandates for automating electronic processes and for making information available digitally to patients. For example:

• When patients come in for visits, they fill in forms on computers in the waiting area. The information automatically updates their clinic note and chart.

• My staff and I can send prescriptions to pharmacies electronically.

• Soon, our patients will be able to securely access their EHR data online, including images, test results, and records. We will also be able to accept images, X-rays and records online via a secure patient portal.

Our compliance with meaningful use is 100 percent voluntary at this point rather than obligatory because of the hyper-specialized nature of our practice and the patient population we serve. Due to the time and expense involved, we’ve chosen not to take the final step of attesting to meaningful use, but we’re continuing to evolve Aqueduct to meet our own ambitious goals for efficient, cost-effective, and quality healthcare for our patients. 

All along, it's been easy to update the system to add data sources and process changes as needed. It's also been easy to take advantage of new FileMaker features. For example, extending our processes and data to mobile devices delivered a huge boost to productivity, efficiency and continuity of care.

Five Tips for Your Own DIY EHR

If you're thinking about going the do-it-yourself route to EHRs, please consider the following tips based on our experience.

1. Take a top-down, end-to-end view. Study your processes and how your people use them. This will help you spot the worst bottlenecks and identify the best opportunities for automation. Think beyond forms and records: The real value comes not just from digitizing data, but from digitally connecting the data with other data and sharing the results.

2. Collaborate, validate, and iterate. Involve everyone at your medical practice in creating the system -design, iteration, and updating. By taking advantage of the different expertise in your clinic ― from your billing people to the nurses and PAs ― you will produce better, more efficient processes. And everyone will have a personal stake in the system's success.

3. Don't forget the back end. Install a robust server (or cloud) back end that can store and share data efficiently and securely, on everything from mobile devices in the operating room to back-office PCs or Macs. Encrypt data at rest and in motion.

4. Remember that time is money and risk. Look for a development tool that makes it easy and fast to create and update your custom solution, without forcing you to master complex programming languages or concepts. Our programmer was very experienced in databases, but had never created a medical application. With FileMaker, it didn't matter.

5. Simplify! Chose a software platform that accommodates multiple devices ― from Windows and Mac systems to mobile devices ― in a single solution, so you can grow with your practice. The platform should also simplify sharing, integration with enterprise data sources, security, and administration.

Our custom EHR system has made our practice efficient, error-free, and adaptable to the demands of an ever-changing healthcare system. Most important, it's ensured quality and continuity of care for our patients by streamlining the data flow. That's meaningful.

Lloyd Hey, MD, is the owner of The Hey Clinic for Scoliosis and Spine Surgery in Raleigh, N.C., which opened in 2005.  Hey's commitment to healing stems from a severe injury at age 16, which almost claimed his left leg and his life. He earned an electrical engineering degree at MIT and a medical degree at Harvard University followed by 10 years on staff in orthopedics at Duke University Medical Center. As a spinal deformity surgeon in orthopedics, Hey also chairs a nationwide board on adult spinal deformity for the Scoliosis Research Society. E-mail him here.