Case Study: Small Practice Implementation
Abstract: Implementation of HemiData EMR in a small practice improves the documentation cycle by, eliminating transcription, reducing the costs associated with creating the documentation and improves patient care by having records immediately available within the practice.
Historical Background: Prior to implementation of the HemiData EMR, the practice used dictation and transcription as a means of creating the notes to document patient encounters. The dictation cycle started with an analog recorder. The attending doctor dictated his notes, the notes being captured on analog tapes that were then mailed to the transcriptionist, who transcribed and returned paper notes back to the clinic. On receipt the transcribed notes they were reviewed by the attending doctor and subsequently filed in the patient’s charts.
In the best of cases, the patient’s charts were current within days of the patient encounter. It was not unusual for the cycle to be extended, particularly if transcription editing and corrections required to the transcribed text. The long turnaround time sometimes impaired the doctor’s ability to review prior notes if a short term follow-up visit was required as part of the patient’s treatment regimen.
From a historical perspective, the practice also wanted a disaster plan. The practice is physically located in an office building. Three years prior, the suite above them had experienced a fire. The fire was contained to the upstairs suite. Unfortunately, the process of extinguishing the fire caused significant water damage to the practice’s records. The process of drying the records went on for months.
As a small practice, they have established reciprocal relationships with other practices to cover for each other during vacations or illness. The practice wanted to have access to their records when they were in these alternate treatment situations and have the ability to provide reports to the their colleagues on their return.
EMR Goals: This historical perspective provided the basis for the EMR implementation goals. The following goals guided the decisions to implement the EMR.
Reduce the cost of the patient documentation cycle.
Reduce the turnaround time of the patient documentation cycle.
Continue their commitment to high quality patient records.
Implement a disaster recovery capability.
Obtain access to patient records when offsite and covering for other local practices.
EMR Implementation: Implementation of the EMR first required some computer upgrades for the office. The office installed a broadband (DSL) Internet connection from a local phone carrier. The practice also purchased the necessary network hardware and laptop computers from a local hardware supplier. HemiData worked with the practice to ensure that the hardware that was supplied met the necessary operational requirements. The practice elected to use a local supplier so that technical support would be readily available in the event of a failure of hardware related problem.
The practice elected to use the HemiData EMR as an application service. Since this is a small practice, they did not want to install servers in their location. HemiData supplies the application service and the back end data management as part of the application service. As part of the service, HemiData performs daily backup of the data, keeps backups in multiple locations and archives to optical media. The optical media archives provide the ability to determine exactly what was recorded on the day of the encounter, should forensic examination be required.
Detailed notes are captured by the EMR and retained as part of the individual records for the patient. The practice eliminated the transcription cycle by using voice recognition software. The voice recognition software instantly transforms the dictated speech into text for storage by the EMR. This eliminated the cost and turnaround time of the transcriptionist. The voice recognition software was a fixed price asset that is amortized over time.
To achieve their goals, the doctors were willing to slightly alter his work habits to accommodate the voice recognition application. Today, he dictates the note, proofreads and edits any recognition problems and stores the result in the EMR. The seamless integration between the EMR and the voice recognition application allows the entire note taking activity to be completed in one step. Once the note is entered into the EMR, the note is instantly available to others in the office and is also available to the physician should a follow-up visit be required.
Offsite storage of the records provided the disaster recovery plan. HemiData stores the notes in three locations to guard against loss of the practice’s data (patient information). The practice gains access to the records using an Internet Browser by using an SSL encrypted connection to their application servers. Since their laptop computers are mobile, they can gain access to their records from multiple locations. Since the application server always establishes a secure connection with the client laptop, the patient information transfer is always secure. The design of the HemiData EMR stores data on the application servers only. No data is actually kept on the laptop computer. This eliminates the possibility of patient information compromise, should a laptop be lost or stolen.
The practice was able to recognize a return on their investment of the computer hardware and software acquisition within nine months of the conversion to the EMR. Ongoing costs for the EMR service and network services are significantly lower than the cost of transcription services, with a result that is more usable.
As a result of the EMR conversion, the record keeping time is consolidated. The doctor uses the time to dictate, correct and store in one operation. This eliminates having to remember, or play through audio tapes to determine what was intended in the original dictation.
The practice elected to leave their existing paper records as they were. The practice selected a “go live” date and began on that date to keep all records electronically. This decision helped the practice meet their financial goals. This did cause some short term overlap in the record keeping systems that has largely been resolved with the passage of time. The practice realized the trade-off that they were making to achieve their financial goals.