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Case Study: EMR Implementation in a mobile practice
Abstract: Implementation of the HemiData EMR for record keeping in a mobile practice setting. Clinicians routinely travel to distant clinics to provide healthcare services in outlying areas. The EMR replaces boxes of records kept in the provider's trunk.
Historical Background: This mobile practice provides healthcare for people who live in remote areas. The practice operates in several small, geographically diverse clinics. The clinician will spend a day or two day at each location before moving on. Members of the clinical staff are rarely together at the same location. Communication between members of the clinical staff is accomplished by cell phone.
Clinicians maintain repositories of patient records in the trunks of their cars. Peer review of records is not possible because the clinicians are rarely at the same place at the same time.
Staff members dictate their notes into recording devices, which are then passed back to the transcription staff for the creation of the completed records. Clinicians must do their own filing, due to their need to keep the records with them at all times.
The practice wanted a better solution to minimize the loss of critical healthcare information in the event of a car accident and to improve the availability of information between members of the practice.
EMR Goals: The historical perspective provided the basis for the EMR implementation goals, which provided the guidance for the implementaion of the EMR.
Operate a record system in a geographically diverse environment.
Improve the availability of patient information.
Minimize the possibility of loss or destruction of patient records and documents.
Improve the flexibility of the record keeping system.
Implement a disaster recovery capability.
EMR Implementation: The basis of this implementation involved a computing infrastructure that allowed the clinicians to work from distant locations. Each clinician was issued a laptop with a cell phone based Internet interface. This allowed the transfer of the patient information when it was needed and allowed the clinicians to share information. This infrastructure worked because the clinicians already knew the cell phone capabilities of each of their locations from previous experience.
The HemiData EMR provided clinicians with a central repository for the patient records. The EMR facilitated the information sharing between clinical workers by providing each clinician with a view of the patients record when peer review was necessary.
Implementation of the EMR made several improvements to the practice. Since the records were no longer in someone's car, this improved both the availability and the security of the patient record. The implementation of the EMR safeguarded the records from physical destruction, in the event of an accident and also provided strict controls on who accesses the patient record that were not possible with cardboard boxes full of folders and paper. The architecture of the HemiData EMR does not store any data on the local hard disk, so patient information is not jeopardized if the laptop is lost or stolen. The local laptops are used as input and display device to provide the clinician with their view to the patient's record. All data communications are secured by the SSL protocol, which totally encapsulates the data during transmission.
Historical patient records were scanned into multiple Adobe portable document format (PDF) files. The scanned documents appear in the patient's current medical record as attached documents. The attached documents provide the history of the patient interaction and the required reference when dealing with long running historical patient care issues.
In addition to the practical record keeping issues solved by the EMR implementation, the practice realized additional value from the time reduction in transferring clinical information to the billing office. Now, when a clinician has completed the patient notes, they are available to the back office staff instantly from the EMR. This reduced, by several days, in some cases, the amount of time required for the back office staff to get the patient records. Previously, the records were only available when the clinician drove past the office and was able to transfer them.
The use of the HemiData EMR application service entirely eliminated a number of manual and time consuming activities for this mobile practice. Previously, when a patient case required interaction with another staff member, be it a member of the clinical or the back office staff, the records had to be located, copied, faxed, etc., to complete the activity. Subsequent to the implementation of the EMR, the clinical staff makes the updates in the patient notes. Once the update is complete, other staff members simply look up the case in the EMR. This has significantly reduced the clerical workload of the clinical staff.
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