The Making of America's Strongest Practices

A home health aide comes to Helen Rackauskas’ house three days a week now, to help care for her 92-year-old husband, who has Alzheimer’s disease. But up until the day last spring that she nearly died - it was Palm Sunday, she says - she’d been caring for him by herself, having rejected the idea of outside assistance. “I never wanted anyone in my home,” she explains. “That’s just the way I am.”

Everything changed on April 4. After sitting up all night with chest pain and shortness of breath that she’d attributed, hopefully, to her asthma, after trying unsuccessfully to treat herself with her inhaler and a couple of Bayer aspirin, she drove herself at sunrise to an urgent care center near her house in Springfield, Ill. It was there she learned she was having a heart attack, and soon the 79-year-old was in surgery, undergoing a risky triple-bypass procedure.

The physicians with Prairie Cardiovascular Consultants, who performed the surgery and have treated her ever since, told her son and daughter that her chances of survival were about 25 percent. Helen - a dignified, feisty, plain-spoken Midwesterner who doesn’t complain much and doesn’t figure to scare easy - was afraid.

She knew that if she survived, her life would never be the same. How would she care for her husband after the surgery? How would her own emotional needs be met? Would she be able to find the time and the strength to do all the difficult rehabilitation work that her doctors would ask of her? And what about the post-surgical pain?

When she arrived at the emergency room at St. John’s Hospital in downtown Springfield, she asked to be treated by the only cardiologist she knew of, James Dove. “Everyone says he’s the best,” she says. Indeed, Dove is one of the country’s leading cardiologists, so Helen’s request was not a small one. But not only did Dove treat Helen, he and his staff treated her with such kindness, care, and attention that she says she will forever be grateful.

“He’s wonderful,” she swoons. “I just can’t say enough nice things about him and his staff. He just made me feel special: ‘You’re important.’ And when a doctor tells you you’re important,” she trails off a bit now, her eyes widening. “I’ve never had a doctor like that. Other doctors aren’t like that.”

A breed apart

In fact, many doctors are like that, and Dove, president and founder of Springfield-based Prairie Cardiovascular Consultants, says he won’t have doctors working for him who aren’t like that. Dove launched Prairie Cardiovascular in 1979 with the idea of developing the kind of large and sophisticated cardiology service for the farming communities of central Illinois that the people of Washington, D.C., and New York, were then coming to expect.

Cardiology has undergone radical changes since 1979 - clot-busting drugs and angioplasty have been developed, and the number of medications to treat cholesterol and hypertension has exploded, to name a few. Prairie has changed a lot, too. The practice started with only three employees - Dove, his nurse Annie Alms, and his first secretary. It now has 43 physicians and 285 employees at seven permanent locations, and its physicians perform a full range of services. It conducts weekly clinics at community hospitals throughout rural Illinois, and is among the nation’s busiest practices in performing cardiac bypass surgeries and angioplasties.

With St. John’s Hospital, its partner in the Prairie Heart Institute, it recently completed construction on a magnificent new facility, complete with operating rooms, a catheterization lab, a high-tech recovery room, and a cardiac rehabilitation center.

But for all the changes, a few things have stayed the same. Annie is still Dove’s nurse. (Dove’s second, and current, secretary, has “only” been with him about 16 years.) Another constant: Prairie Cardiovascular’s devotion to its mission of providing high-quality, personal care with warmth and compassion, an ethic that begins with Dove and flows to every staff member, from physicians to nurses to the billing clerks.

For example, Helen says the practice sends all of its post-surgical patients home with an oversized teddy bear, instructing them to squeeze it hard to brace themselves against the pain of a coughing spell or jostling in bed. It was a godsend, she says, and she would often encourage other patients in her cardiac rehab sessions to “hug your bear.” When she was first discharged, Helen adds, “Annie would call me every day at home just to see how I was doing,” recalls Helen. “Sometimes twice a day. Oh, I got so lucky.”

In truth, luck had very little to do with it. For its devotion to quality care without ever forgetting the importance of the physician-patient relationship; for its remarkable achievement of building one of the country’s largest and most successful cardiology practices despite the challenge of its rural location and an ongoing shortage of cardiologists nationwide; for its use of technology to enhance efficiency, clinical excellence, and patient satisfaction; and for being a great place for physicians to practice and employees to work, Prairie Cardiovascular Consultants is the 2004 Physicians Practice Practice of the Year Grand Prize Winner.

The Practice of the Year contest, launched two years ago as a way of recognizing practice excellence and offering groups around the country a model for efficiency and practice management innovation, was at its most robust this year. Practices from every part of America entered, and the applications were among the most detailed and sophisticated Physicians Practice had ever received.

And the judges’ choice of Prairie Cardiovascular was the most decisive to date. Of the five expert judges, including the heads of the two previous Practice of the Year winners, four put Prairie Cardiovascular at the top of their lists. (Learn more about the judges on page 32.)

“I’m very proud of what’s happened,” says Dove, in an early-morning interview in his modest third-floor office. He’s talking less about the contest recognition than about the growth and success of the group he founded, from which he will retire at the end of the year. Dove has been Prairie Cardiovascular’s heart and soul since its beginning, but he credits others with its success: “It’s happened because there are phenomenal people here; I’ve been very fortunate to have partners who are just wonderful to work with. They’re very responsible and high-quality. I also have been lucky in terms of the administrative staff - it’s a very good staff that helps to carry the ball and really understands the direction of the group.”

Recruiting challenge

Springfield is a small state capital about two-thirds of the way to St. Louis from Chicago on Interstate 55 and is surrounded by hundreds of miles of, well, not much.

“We don’t have oceans and we don’t have mountains,” Dove says matter-of-factly, describing one of Prairie’s biggest challenges - physician recruitment. In truth, Springfield, a town of about 111,000, offers scant cultural events, no professional sports teams, little nightlife, and no major university (though Southern Illinois University’s medical school is based in town). Its major attractions are the scads of Abe Lincoln-related historic sites and the state fairgrounds.

“If I were single, it would be hard to want to come to Springfield,” says Marc Shelton, MD, a member of Prairie’s executive committee. “I’d want to go to San Diego or someplace glitzy.”

The man who will take over for Dove next year, president-elect Frank Mikell, MD, who has been with the group since the mid 1980s, agrees. “If you’ve lived your entire life in New York or San Francisco, and you just fly into the Springfield area, it’s quite a shock,” he says. “You think you’re lost. A lot of people rule us out on the basis of geography.”

But a mere willingness to live in Springfield is hardly enough. Mikell says the group uses physician recruiters sparingly, preferring to identify candidates through “personal contacts,” but still throws away about half the resumés it receives. “The first criterion is: Do we think this person has the training to achieve what we want clinically?” Mikell says.

If so, a senior partner conducts a lengthy phone conversation with applicants, explaining Prairie’s practice philosophy and style and the nature of its location.

Philosophically, one thing that distinguishes Prairie is its insistence on continuity of care. Elsewhere, cardiologists spend all day performing one function - say, catheterizations - because it’s easier to schedule the physicians. At Prairie, each physician does whatever his patient needs at the time.

“If Sally Sue has [a heart attack] and I see her first when she comes in, she’s forever identified as my patient,” explains Shelton. “So I do the follow-up … and that kind of continuity of care is vital. That’s a plus for patients. … The downside is that it is harder to schedule. Sally Sue might come in with chest pain [unexpectedly], and I’m going to [see her].

“Whereas in the emergency system, on Tuesday you’re doing caths, on Wednesday you’re reading echocardiograms,” Shelton continues. “The patient may interact with three or four different cardiologists. That works best for the physicians but not the patient. One of the reasons this group has worked so well is because referral physicians know that we’re going to treat their patients well. And patients want to come here, when they could go to St. Louis or Chicago, because they get that kind of service here. I think that’s the main reason this group has grown.”

That patient-first philosophy is etched in everything Prairie does, and physician recruiting is no exception, says Mikell. “People understand when they come here that we have a certain practice philosophy,” and those who aren’t comfortable with it aren’t hired, he explains.

Physicians are king

Dove is an Ohio native who moved to Springfield after he completed his residency in the late ’70s because he and his wife were looking for someplace nice, safe, and simple to raise their children. It’s a decision he says he’s never regretted. Indeed, many of the physicians who come to Prairie are mid-career doctors or those with young kids whose priorities are different from many of their single or childless colleagues. They tend to be “in a family way,” says Shelton.

“It’s definitely a family kind of a culture,” he says. “In our hallways, a lot of the talk is about, ‘How are your kids? How’s the football team? How’s soccer practice going?’”

But what Shelton says he likes best about Prairie is the physician-centric management philosophy, including the autonomy the doctors have to structure their offices their own way, provided they follow the group’s strict clinical guidelines. Many of the group’s doctors are “academic refugees,” escaping a “communistic environment” in which incentives to make more money by working harder don’t really exist, and where resentments grow when some doctors work more than others.

In an academic setting “the overhead is humongous,” he says. “And when it’s all said and done, you might be bringing in 15 percent to 20 percent of billing. In a private practice, I’m doing the same quality of medicine and we get great results, and I don’t have to put up with the [same degree of overhead]. So on the production side, there’s a big plus.”

There’s not much reason at Prairie for physicians to resent one another’s workloads, since they are generally free to work a little less provided they’re willing to make a little less, Shelton says. That’s one of the reasons they remain a tight-knit group.

At Prairie, the physician is king. As chief executive officer, Gregory Timmers is the group’s highest-ranking administrator, but he has no illusions about being in charge. On the contrary, he speaks proudly of the low turnover on its physician-only board of directors because it helps maintain physician oversight and control.

“Some groups struggle with whether low board turnover is good or bad, but if you encourage rapid turnover, you inevitably and overwhelmingly empower nonphysicians like Ed [Brooks, Prairie’s chief financial officer] and myself, because we’re the only ones who’ll have the knowledge, the background, and the institutional memory to run the place,” Timmers says. “Better to maintain longevity and consistency of governance; that’s the way we elected to go. And because they’ve been so committed to living by our mission statement, we’ve been fortunate in the 25 years we’ve been in existence that we’ve never had to reverse a decision or had any big regrets.”

So Springfield may not have oceans, mountains, or Broadway, but it has crucial advantages and makes the most of each one in its recruiting. Among them are physician control and autonomy, a warm and inviting place to work and raise a family, a relatively low cost-of-living, a reputation for clinical excellence, high volumes of varied procedures, and an opportunity to conduct research, rare in private practice, at a Prairie-created research institute across the street from St. John’s Hospital.

Prairie maintains “an incredibly flat organizational structure,” says Timmers, “so physicians know they have ready access to all of us. Our group is organized as if it’s 43 individual private physician practices - each physician has his or her own dedicated staff, which they hire themselves. We’ve created an office structure for them; the commitment within their three- or four-person teams is high. Our business cards list the physician’s name in the center and in the bottom corners are the names of the physician’s nurse and administrative assistant. That is the team - and that’s what leverages the practice, because the patient is going to relate to that team.”

Administrators provide support and guidance, not marching orders. “Our goal is to make each individual practice function as easily as possible, so the docs spend their time being docs. That’s why there isn’t as much conflict as you would expect in a practice of this size. In our case, conflict between the physicians and the management has never been an issue - because if you asked our physicians they’d tell you that they’ve never felt they couldn’t practice medicine the way they want.”

EMR pays off

That is, unless a physician is failing to meet the clinical guidelines set down by the American College of Cardiology. In that case, the doctor will be alerted to the deficiency by the group’s new electronic medical record so it can be corrected. That’s one of the best aspects of the system it purchased in 2001 from Medinformatix, which includes an integrated EMR and practice management system, says Dove.

“The system has both administrative benefits and clinical benefits,” says Dove. “The practice can evaluate whether physicians are remaining on task with recommendations of the ACC because the system has those standards preloaded [and can be easily updated]. So when physicians document what they do, the system prompts them to perform whatever recommended tasks have not been done, and allows practice evaluators to compare physicians’ actions against the recommended actions.”

Staff and physicians agree that training and deployment of the system was no easy task - virtually all 285 employees had to learn a new way of doing something, from scheduling to billing to medical documentation. Some of the physicians, Dove admits, were at first resistant to change, but “sometimes leadership is about getting people to go where they need to go, but don’t necessarily want to go.”

Today, the group couldn’t be more thrilled with the results. In administration, scheduling has become almost indescribably simpler. “In our practice, the nurse and secretary in each physician’s office handle the clinic schedules for that physician,” according to Prairie’s Practice of the Year application. “The benefit of the new system was immediate since they could now print and track schedules electronically.”

Another important benefit of the new system was that it enabled the group to bring its billing and collections in-house, canceling its contract with an outside service. The group’s leaders figured the new system would allow it to capture and bill for more charges. They also believe that the practice’s compassion-infused mission extends to billing: by having its own billing staff they’d be improving patient satisfaction, allowing patients to deal directly with the practice instead of some third party.

This was a calculated risk. In addition to the cost of the system itself, the plan to bring billing in-house would require the addition of 23 full-time-equivalent billing staffers, almost all at once. Even so, the group’s gamble paid off.

Even factoring in the new staff, “the new billing system managed to virtually pay for itself by increasing collections 5 percent. This was made possible by unlimited access to billing and collection information that is now available through reports created in Medinformatix,” the practice wrote in its application. Yet even with the increased collections, “billing complaints from patients have decreased.”

Claims submission, check posting, and the processing of Medicare explanation-of-benefits forms are all done electronically now, saving the practice time and money. The system can process about 1,200 patients’ EOB forms in a few seconds, and it deposits about 8,000 checks per month in an electronic lockbox. The electronic check-processing has allowed Prairie to slash its check-processing fees 70 percent.

“You can access on the computer every check a patient sends us the same day we receive it,” says Brooks, the CFO. “You can search by people’s names, dollar amount, by date. The hard part of implementing the new system was all the training. But when you looked at all the efficiencies it brought, with all the outsourcing we were doing before … it was absolutely worth it.”

Like a family

Dove’s impending departure has left many at Prairie with mixed emotions. In their typically meticulous fashion, the physician leaders have been planning for his retirement for close to five years, and Mikell was chosen as his replacement after a lengthy deliberation, in part because his long tenure is reassuring.

Even so, no one is quite sure what Prairie will be like without Dove, and they’re not entirely eager to find out.

“I’ve known Jim for a long time, and I have a deep respect for him, and a deep love,” says Mikell. He says he must be “crazy” to even want to follow such a legend, but he will consider himself a transition president, helping to ease the practice into life after Dove. “The group has really been like a closely held family, and Dr. Dove has been such an integral part of that. No one will ever serve as long as he has, or in the same way.”

As for Helen Rackauskas, she was a faithful attendee of her three-day-a-week cardiac rehab sessions, took long walks on her “off” days, and went to most of the optional education classes the practice and hospital sponsor - some of them twice. It wasn’t easy leaving her husband at home. “But I tried to do everything they asked me to do, because I want to get well,” she says. “I have to do it for my own health, or I won’t make it.”

Helen says she made new friends, which she desperately needed, during her recovery. She and other Prairie patients were carefully put through their paces at the rehab facility, and over time they bonded. When the sessions ended and the patients “graduated,” they hugged and cried and wished one another well.

“We became a family after so many weeks,” she recalls. “It was, ‘How many bypasses did you have? Does your back hurt? How do you lie in bed?’ We became like a little support group, and that was so good. We were like a little family, and it was hard to leave one another.” n

Bob Keaveney, editor for Physicians Practice, last wrote about developing policies to treat the uninsured in the October issue. He can be reached at bkeaveney@physicianspractice.com.

Runner UpRichmond Bone and Joint ClinicRichmond, TexasPractice type: Orthopedics/ Sports MedicineEstablished: 1996Physicians: 6Employees: 53Patients: 20,000Locations: 2Web site: www.rbjc.com

Juliet Breeze, MD, is a faithful reader of Physicians Practice, and she puts what she reads to work at Richmond Bone and Joint Clinic. That’s particularly evident in the way the staff members are given ownership in their positions and how their dedication translates into exceptional patient care and attention to patient needs.

“That’s not my job” is a notion that doesn’t exist at this practice. “We encourage employees to make changes to their position if those changes make them more effective,” says Breeze. As a result, billing and front-desk staff work cohesively, rather than at odds, and scheduling processes have been improved.

For example, one of the billers was consistently seeing denials from a certain payer. Instead of blaming the front office and letting the problem continue, she talked to her coworkers and discovered they didn’t quite understand what she needed. Now this biller is also a trainer, spending a week or two with front-office staff members to familiarize them with what goes on in the back.

And one of the schedulers began seeing patients slotted incorrectly; the physicians often weren’t seeing the right type of patients. She took responsibility for reviewing the schedule a day or two in advance to ensure that patients and providers are appropriately matched up. Now, the surgeon who prefers knee and shoulder cases sees those patients, and one nonoperative physician isn’t scheduled to see patients who might require surgery.

Teamwork is more than a concept, it is lived. One creative staff member has added to her job description the role of teambuilder. She plans teambuilding games and exercises, like relay races and scavenger hunts held at monthly staff meetings, to let the group blow off some steam. Plus, says Breeze, “it lets people team up with people they might not normally team up with.” And with team incentives built in, the practice has seen some impressive outcomes.
Breeze says the front-office team was offered a bonus based on the number of new patients seen, patient balances collected, and claims errors made. At the end of each month, each team member would receive $100 for each 10 percent increase in the number of new patients over the previous year’s best month; an additional $100 for every additional $10,000 (over $30,000) collected at checkout; and still another $100 if claims data were completely error-free.

Suddenly, folks were jumping in to help the telephone operator; schedulers became practice ambassadors in hopes of increasing word-of-mouth patient referrals; check-in became “data errors checkpoint.”

The results were clear: clinic-wide collections rose by one-third from December to March, and the number of new patients seen jumped from 590 to 800 in the same period.

But the best part has been how patients have noticed the changes. Using the practice’s “Star Employee” cards, patients are encouraged to think about the quality of their experience there. It’s not uncommon for several staff members - from the scheduler to the X-ray technician to the physician - to be recognized together by a single patient. According to one, “I was told my expectations of the medical community were too high. Based on my experience at Richmond Bone and Joint, professionalism still exists.” And that, says Breeze, is what makes the practice flourish.
-Joanne Tetrault

Runner UpA Woman’s ViewHickory, N.C.Practice type: Gynecology/Internal MedicineEstablished: 1996Physicians: 2Employees: 4 midlevel providers, 31 staffLocations: 1Web site: www.awomansview.com

“Staff makes this thing work,” declares John Lovin, practice administrator for A Woman’s View, a second-time winner in the Practice of the Year competition. “I’m just proud to be a part of it.”

Indeed, a unique perspective on staffing is part of what makes the practice stand out. A Woman’s View makes sure “we have enough personnel to not only cover the tasks, but to give each employee some ‘slack’ time to plan, think, and stay organized,” Lovin says. “You don’t want to have somebody for whom every single working moment is packed with something to do.”

Providers, too, are scheduled with downtime built in. Physicians see only two and a half patients per hour. The average for a gynecologist is four an hour, Lovin says.

How does the practice manage to create all that calm?
Partly by having more staff than average. With three physicians and four nonphysician providers, the gynecology and internal medicine practice has 31 staff members. That equates to 4.4 staff per provider, over the 3.5 staff per provider median documented in the Medical Group Management Association’s “Cost Survey: 2003 Report Based on 2002 Data.”

But the practice also makes the most of the people it has by hiring well in the first place. “We hire good people that we can train. We try to find people that care about other people and have a passion for healing,” Lovin says. The practice then supports them with education and a fun environment.

Lovin will also place staff in positions that reflect their strengths. A former phone operator now does collections. “There are some people who don’t mind calling to say, ‘You owe $100.’ … The new person takes it as a challenge.”

Similarly, a full-time appointment coordinator handles all scheduling calls and places personal reminder calls, replacing an automated system. “When I first started doing this, we had five or six people running the support side of the operation. Every day, one of them would answer the phone for the morning shift, another for the afternoon shift, and they would bounce back and forth taking turns because no one liked doing it,” Lovin recalls. That meant no one really made the job their own. The full-time focus adds efficiency, and the reminder calls have cut the no-show rate at least 25 percent, Lovin reports.

Lovin also staffs more unusual positions, including a billing auditor who reviews all encounter forms before claims are sent out. Sound expensive? Maybe - but the auditor is catching a lot of missing charges. In the first five or so months of having the auditor on staff, over $19,000 in net missing charges were corrected and properly billed.

The practice enhances its bottom line and marketing appeal by offering fee-for-service “extras” to its patients. There is VersaPulse to treat spider veins, ClearLight acne therapy, cyroblation therapy, and Thermage, a radiofrequency process to tighten skin and stimulate collagen growth. Since Thermage can cost a patient $3,000 out-of-pocket, A Woman’s View can arrange for financing with a local bank. But the ancillaries aren’t just revenue builders. A DEXA machine - which brought in over $60,000 - also caught over 400 cases of osteopenia or osteoporosis in the first year the practice had it.
-Pamela L. Moore

Runner UpLawton Chiles Children’s Health CenterBradenton, Fla.Practice type: PediatricsEstablished: 1979Physicians: 4Nurse practitioners: 2Employees: 24Patients: 28,000Locations: part of 7-site Manatee County Rural Health ServicesWeb site: www.mcrhs.org

The stated mission of Manatee County Rural Health Services is “to provide quality service to the underserved.” It’s a goal that Xavier Sevilla, MD, takes seriously - and it shows at Lawton Chiles Children’s Health Center, where care teams and advance access are just two new approaches designed to make patients’ lives easier.

“Indigent and underserved populations like ours have historically been at the bottom of the service pyramid in the healthcare system,” says Sevilla. Long waits, poor access, and lack of continuity of care are major obstacles.

When he came out of residency in 1999, Sevilla says he had an “idealized vision” for what medical practice would be like, but he soon “crashed upon the reality of dealing with angry patients and getting home late. This can’t be the way it is!” he recalls.
For inspiration, he turned to the Institute for Healthcare Improvement (IHI), a nonprofit organization that spearheads various initiatives to improve safety, quality, and efficiency in healthcare. He came back from an IHI conference ready to put new ideas to work.

One of the practice’s biggest challenges has been a high no-show rate and difficulty reaching patients to remind them of appointments. Sevilla estimates that 50 percent to 60 percent of his patients live in homes without a working phone. Transportation difficulties are common.

To address access problems, the practice eased into a new approach. In March 2002, they began to introduce open access, whereby patients can be seen on the same day, or within a day, of their call for an appointment. By May 2004, they had worked through the backlog and now operate fully in open access. Miscellaneous appointment types - physical, well-child visit, asthma visit, etc. - have been eliminated and replaced with a 15-minute standard slot that can be doubled for visits that require more time (ADHD, for example). The result? “We still have some no-shows even with same-day appointments,” says Sevilla, but the overall rate has dropped from around 40 percent to around 15 percent.

To improve continuity of care, the practice established care teams, each consisting of a physician, nurse, nursing assistant or medical assistant, and a patient care coordinator. Teams meet every morning for a 15-minute huddle to prepare for the day’s patients. Each team has its own phone number and fax to streamline patient calls, refill requests, and other communications. Patient waits have improved, too, from 66 minutes to 14 minutes. Almost all components of the visit - insurance or sliding fee verification, triage, history, immunizations - are done in the exam room. The space that once was the waiting room is now an information center, complete with computers running reading software in English, Spanish, and Creole.

Throughout it all, Sevilla has acted as the “physician champion” - the one to push for change and act as the middleman between the other physicians and health center administration. It’s human nature to resist change: “People don’t want to give up the safety and security of what they know,” says Sevilla. “Once they saw the efficiencies and the decreased wait time, we could point to these as examples of good change.”
-Joanne Tetrault

Runner UpNorth Fulton Family MedicineAlpharetta, Ga.Practice type: Family MedicineEstablished: 1991Physicians: 8Employees: 54Patients: 51,000Locations: 2Web site: www.nffm.md

In 1998, North Fulton Family Medicine made the decision - well ahead of many practices - to pursue electronic medical records (EMRs). Today, the practice bills itself as a regional leader in technology, having worked with local hospitals to improve communication and exchange of information electronically.
“We mastered this system [A4 Health Systems’ HealthMatics practice management and EMR products] to increase efficiency, which translates into money and time saved,” says Jim Morrow, MD, one of eight physicians on staff at the family practice. “We did this with a ‘take no prisoners’ attitude of making full use of the EMR and supplying staff and physicians with all the training and quality equipment they would need to succeed.”

The return on the practice’s investment has been substantial. Since 1998, the number of patients processed per day has increased 69 percent, from 100 to upwards of 330, without an increase in staff. About $775,000 in transcription costs has been recouped. And chart-handling time has been completely eliminated, saving more than 10 hours of staff time per day.

The lines of communication have also opened up, now that North Fulton provides 24/7 interaction between physician and patient.
“E-mail is rapidly replacing the telephone as the primary means of communicating with patients. It is faster, more secure, easier, and cheaper than the phone,” says Morrow. “Replying to phone messages and e-mails from patients is so much simpler now that we can communicate so easily.”

Since the majority of North Fulton’s patients are technologically savvy, they are thrilled to be able to communicate with the practice online at www.nffm.md when it’s convenient for them. “Patients have the ability to view labs, request refills, view dates of visits and diagnoses given,” says Morrow. “They can send secure messages to anyone within the practice, directly into the EMR.” An online Web survey offers one more opportunity for patients to communicate.

The overall reduction in paperwork and a more streamlined workflow make North Fulton an increasingly appealing place to work. Nurses and doctors have more time for their families now that they are able to finish work by 5:30 p.m., rather than 6:00 or 6:30. In addition, many people have come to interview for positions with the practice specifically because of its great reputation for EMR use. They see the difference the minute they walk through the door.

As a result of its successes, North Fulton will expand to include a third clinic (in addition to the two based in Alpharetta and Cumming, Ga.). “We are just taking this to a new neighborhood in Woodstock, Ga. By enjoying the efficiencies of scale that are integral to a computer network, we have been able to grow more than we ever thought possible,” says Morrow.
-Erin Romanski

This article originally appeared in the November/December 2004 issue of Physicians Practice.