There are answers to the automation puzzle in small physician offices, experts say, and they can be found with the right system from the right vendor.
While this may sound like a typical IT platitude, finding the right system is an all-too-real aggravation, especially for small practices, says Shawn Remacle, technology strategist for Redmond, Wash.-based Microsoft’s US Public Sector Health.
“A lot of practices with less than 10 doctors have no IT staff and just go by word of mouth,” he said. “So if one practice buys a system, practices all over town will buy the same thing. But what works well for one practice doesn’t necessarily work for others and they don’t realize it until they find out ‘it doesn’t do what I want to do.’ They need more upfront due diligence on their part.”
Though some practices are still stuck in manual mode and buried in paper, the migration to automate processes is increasingly going beyond back office functions and into more comprehensive electronic medical records, said Carl Buising, MD, executive director of health for Microsoft’s Public Sector Health. The advanced sophistication of these systems has added to the frustration of choosing the right vendor, he said.
“Physicians are busy people and it’s hard to adequately assess the variety of EMR systems out there when you don’t know the field,” Buising said. “The integration into the workflow and corresponding changes are disruptive. It’s not easy to plop in a system and expect it to work. They need to go into it with their eyes open.”
Whether it’s from the system vendor, a professional consultant or trade association, practices without IT staffs need to solicit support, Buising said.
“You need to have the expertise in order to navigate the conversion process,” he said.
Remacle adds that physicians also need to realize “it’s not going to happen in one weekend. The more they become engaged, the more it will change their practice and deliver what they hope to get out of it.”
Synergy Found
One of the fastest growing specialties, hospitalists, is becoming increasingly influential in bridging the gap between physician practices and hospital administration. Census figures from the Phoenix Group think tank show approximately 20,000 hospitalists working in medicine today and the numbers are expected to grow to 30,000 over the next several years.
Hospitalists in Maryland and Louisiana were looking for a system that corresponded specifically to their needs and found the ideal product from Atlanta-based Ingenious Med, designed by fellow hospitalist Steven Liu, MD.
Tim Capstack, MD, had the advantage of working with Liu when both were residents. As a result, the program director for Anne Arundel Medical Center didn’t have to look far when the organization started automating its manual processes last year.
“Knowing Steve was definitely an advantage,” Capstack said. “Because he is a hospitalist, he knows that population and designed a system that addresses our needs. It is a very intuitive product, organizing things the way a hospitalist would. We were able to transition within a week or two.”
The eight-physician Arundel practice is part of Annapolis, Md.-based Care Specialists, which also includes Prince Fredrick and Calvert Memorial hospitals. Though Arundel has its own separate system for EMRs, lab interface, note creation and documentation, the Ingenious Med product works alongside them and helps with census and tracking, Capstack said.
Lafayette, La.-based Schumacher Group provides hospitalist services at 10 facilities across several southern states. David Grace, MD, says the creation of hospitalists has helped move patients efficiently through the healthcare system. With 35 physicians serving as area medical officers, the Schumacher Group contracts with hospitals to manage emergency room patient flow using the Ingenious Med system.
“We’re not just placing doctors, but good running systems,” Grace said. “We have an abundance of infrastructure – the doctor is central to it, but it doesn’t end with just the doctor.”
Grace likes Ingenious Med because it’s easy to install, offers a fast learning curve and fits into each hospital’s existing system.
“All we need is an Internet or smart phone connection and we’re up and running,” he said. “It meshes with any hospital we go into.”
The system’s functionality is tailored to the hospitalist’s responsibilities, offering a view of which physicians are on duty, who is busy and who’s available. This transparency helps unplug bottlenecks and clears out the ER, he said.
“It’s like an EKG for the practice – it monitors the heartbeat of activity,” he said. “It allows us to get things done at top speed.”
‘Good Business’
While many practices continue to struggle with selecting the right system, a small minority is well established with automated procedures. Westchester (N.Y.) Medical Group, a practice of some 150 physicians, implemented the GE Healthcare Centricity Practice Management and EMR system in 2002 and has been reaping benefits for several years.
By forging ahead unabated with implementation, the practice earned a return on investment after the first year through staff reduction and paper handling, including shrinking the number of full-time equivalent medical record employees from 23 to six and lowering the number of physician support FTEs from five to 3.2. Total personnel overhead savings exceed $6 million per year and transcription cost savings total about $500,000.
President and CEO Simeon Schwartz, MD, contends there was virtually no resistance to adopting the system because the partners grasped the financial and operational benefits from the beginning.
“It’s good business – it represents value for our shareholders,” he said. “Because we are operationally efficient, they benefit in several very clear ways. The second thing is that we have marketed ourselves as providing coordinated quality care and if you don’t measure quality, you don’t have quality.”
