To The Max: Get the Most from Your EMR

It was the middle of the night, and one of Tim Baird’s patients was in the emergency room. The ER doctor treating her needed more information before he could proceed. He was pretty sure he’d be unable to obtain the answers he needed at that late hour, but he called Baird’s OB/GYN office anyway and had him paged. Baird awoke to the beeping of his pager, but rather than call the ER physician with what little information he could recall about that specific patient, he powered up his laptop and quickly downloaded her entire medical file. He was able to give the ER doc everything he needed to know to treat the patient immediately, including her updated lab work.

“The doctor in the ER was amazed,” Baird recalls.

But Baird wasn’t. He says instant access to his patients’ data anywhere, anytime is just one of the daily upsides to fully utilizing his practice’s electronic medical record system, which went live when his practice opened its doors in summer 2004.

It didn’t happen right away, says Baird, but after about a year, he and his two physician colleagues at Women’s Physicians of Jacksonville, Fla., found themselves well-versed in just about every application their system offered. After all, he explains, they couldn’t afford not to. The practice spent $146,000 to implement the system, and it pays $1,600 a month on IT maintenance.

But Baird admits that the learning curve was a steep one.

“When you first start using your system, you’re just trying to survive,” he explains. “But after a while, several of the really nice components - the bells and whistles - start to become apparent. Then you pick the ones you’re most comfortable with, and you work hard to come up to speed on those.”

Unfortunately, Baird and his colleagues aren’t the norm when it comes to getting the most from their EMR investment. Only about 25 percent of physicians’ offices have EMRs, and of those that do, only a small number use the majority of the applications their EMRs offer. According to Rosemarie Nelson, a health IT consultant with the Medical Group Management Association (MGMA), there is no survey that shows how many practices adopt EMRs as completely as did Baird and his colleagues - but she estimates that it’s roughly 30 percent.

“Generally, most EMRs go unimplemented,” says Nelson. “And once fully implemented, they stall for one reason or another.”

Why? “Change management,” she explains.

“It requires physicians to change the way they document their visits, and that’s hard to do after years of paper charting.”

But, Nelson adds, once a practice manages to get its physicians over that initial learning incline, the rewards can be remarkable.

Getting fancy

Take, for example, interoffice electronic communications - the process by which doctors and nurses communicate about patients using computers or hand-held devices while the patient in question is in the office. Most EMRs include this function or it can be added on, but few practices take advantage of it - much to their detriment, says Pam Wostarek.

Wostarek, the regional implementation manager for Horsham, Pa.-based NextGen Healthcare Information Systems Inc., explains that a doctor employing this option can, for example, make notes on a hand-held device about a patient during her office visit and then instantly send those notes to a nurse, who may need to act on them immediately. In addition to enhancing efficiency, the device leaves an electronic paper trail.

“Doctors are used to walking out into the hall and talking to somebody during or after a visit - but that’s not documented anywhere,” says Wostarek. “This is better for everyone.”

Some practices that really have their EMR systems on full tilt will go a step further by adding patient flow and tasking into the mix.

According to Don Shoen, CEO of MediNotes Corp. of Des Moines, Iowa, many EMRs, with proper manipulation, will allow physicians and their staff to track which patients are in which waiting rooms and how long they have been there. Some programs even allow doctors to view a stored photo of each waiting patient as they pass a cursor over diagrams of their various exam rooms. Knowing who is in which room eliminates the need for paper charts slipped into file holders attached to each exam room door, thus increasing patient privacy.

These capabilities also allow doctors to enter examining rooms with a ready apology if they know a patient has been waiting for an extended time, adds Shoen.

And subsequent tasking can flow from that point. For example, once a patient is in an exam room and waiting to see a physician, an EMR’s tasking function can automatically alert the nurse or medical assistant that it’s time to take that patient’s blood pressure and vital signs. The EMR then provides a template into which the nurse can enter the patient’s data. The system can be further configured to trigger an electronic message to the lab, telling staff there it’s time to draw the patient’s blood. After that task is completed, the doctor can receive a message on her hand-held device letting her know the patient is now truly ready to be seen.

“This offers a lot of great office efficiency,” says Shoen.

Of course, he adds, this is not the first stuff you learn when your EMR is being implemented, and doctors shouldn’t despair if they haven’t yet come this far.

“The brain is like a sponge - there’s only so much you can retain when you’re first learning,” Shoen says. That’s why it’s important for doctors and their staffs to keep coming back for more training, as many EMRs have seemingly endless applications that can be applied to help practice operations flow ever more seamlessly.

“It’s like Microsoft Word - there are tons of features that so few people even know about or take advantage of,” says Shoen.

Enhance patient communications

One EMR feature that’s allowing a growing number of practices to begin to reap benefits is preventive health and disease-management reporting.

To take advantage of this capability, says Dan Pollard, director of product management at Misys Healthcare Systems, a practice’s staff programs its EMR to query all medical records and flag those of, say, all men over age 50. The system can then be set up to mail postcards to each of these patients informing them it’s time to come in for a preventive colonoscopy. Or, if the practice prefers, the system can merge with Microsoft Word and generate a list of names and phone numbers that staff can call to make appointments.

“This is a very important way to leverage the power of the electronic medical record,” says Pollard.

Flowing from that concept, adds Nelson, is the patient portal. Rather than mailing postcards reminding patients of the preventive services they are due for, many tech-savvy practices will send patients e-mails directing them to the practice’s password-protected Internet portal.

Once they log on, patients can preregister for appointments, find out what preventive care visits they may need, and receive recent lab results complete with lay-language interpretations.

According to Nelson, these services can speed up daily office procedures tremendously, as many overworked practices allow significant time to elapse before calling patients with lab results. Often patients call them first, which can further interrupt office work flow. Unfortunately, says Nelson, only a small percentage of practices with EMRs take advantage of the patient portal capability. It’s just one of those oft-ignored features.

“It would facilitate office visits incredibly if doctors were able to realize the impact of communicating with patients this way,” says Lucinda Israel, also a regional implementation manager for NextGen.

But physicians are beginning to catch on. Baird’s practice is looking into the power of patient portals now, and he hopes to go live with them by the end of the year.

Exploiting the basics

Many practices fail to use EMR features that some consider very basic - such as electronic transcribing, e-prescribing, and interfacing with labs and pharmacies.

Nelson says using simple electronic transcription applications - an element of nearly all EMRs - allows patient visit information to be imported seamlessly into a patient’s chart, thus skipping many formerly necessary steps. The upside of doing this is undeniable, she says: “It allows doctors to increase productivity by one patient a day, and for most physicians, one patient a day across a year will pay for a transcriptionist.”

Nelson is also a big advocate of using an EMR’s e-prescribing tools, particularly when it comes to refills. If done the traditional way, this process entails many inefficient steps, but if it is performed electronically, it happens very quickly. And everyone’s happier.

Tee Green, president of Greenway Medical Technologies, agrees.

“Take a traditional paper practice,” he says. “A patient calls, says he needs a refill of Allegra. Nurse pulls the chart, sends it to the doctor. Doctor approves it or doesn’t approve it. Phone staff calls the pharmacy. This can take two or three days. If the patient calls a practice with a good electronic system, though, the request is sent to the nurse electronically, who messages the doctor, who has the chart right in front of him. He approves it, and, in some systems, he can interface with the pharmacy directly.”

Nelson says the day in which the majority of practices take advantage of most of their EMR features is slowly coming. Until then, she’s happy to witness the small victories - the occasional interest in patient portals, the willingness to dip one’s toe into electronic transcription - that are occurring along the way.

Suz Redfearn is an award-winning healthcare writer living in Falls Church, Va., who for over 15 years has written for a variety of publications, including The Washington Post and Men’s Health. She can be reached via editor@physicianspractice.com.