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Making the bells and whistles work smoothly
A
Corpus Christi practice’s implementation experience
By Stephanie Svoboda
Kent E. Tompkins, MD, and his staff are what you would
call electronic health record (EHR) super users. In less than two years,
the solo family practice smoothly implemented an electronic system and
got most of the bells and whistles working to their advantage. In part one
of this three-part series, we look at how this practice added value to
their purchase through the use of an integrated practice management system,
as well as e-labs and e-prescribing.
In May 2005, Kimberly Tompkins wondered to herself, “What
did we get ourselves into? Could we turn back now if we wanted to?”
Tompkins, office manager for her husband’s family
practice clinic in Corpus Christi, had recently helped to transition the
practice from paper to electronic through the purchase of an EHR. The
practice decided nearly five years ago to move forward with an electronic
system. The staff prepared ahead of time for what they wanted, did site
visits and tested various systems. In the end, they were confident in their
choice.
“We were motivated and ready to do this,” she said.
“But, even then, you reach a point where you question whether your decision
was the right one. It’s painful, but the end result definitely outweighs
the difficulties you face at the time.”
Tompkins strongly recommends having one person who is
responsible for leading the EHR implementation, and to have them take “lots
of names and numbers and notes.”
“In hindsight, I can now see that we started with too
many cooks in the kitchen at first,” she said. Tompkins related that they
had multiple people trying to communicate with the EHR company about their
needs and issues—herself, the physician and the nurse. “It got very
confusing within our office, but it also got confusing when we would call
the vendor since we would speak to different people in the company.”
Many practices choose a physician champion to lead
them through the implementation process, coordinate vendor communication
and keep the implementation rolling along. In this case, it was most
helpful to the practice to have the office manager fulfill this role.
Tompkins maintained a manual documentation record of whom she talked to,
what they agreed to do and by when they would do it.
“The reality is that people leave EHR companies all of
the time. We had to be clear about our own direction so that if we ended up
working with a different vendor contact, we were prepared to move forward
rather than playing a game of he said, she said. I had to get in the middle
several times and say, ‘Alright guys, what do we need to do to get this
done?’’’ Tompkins said.
From the beginning, Kent E. Tompkins, MD, knew he
wanted to maximize the functionality that EHRs had to offer. He and his
wife began by choosing a vendor that offered an integrated practice
management system and the EHR.
“There is definitely an advantage to having the two
systems integrated,” she said. For instance, when the receptionist at the
front makes a change to the patient’s demographic information (e.g.,
address change), this goes directly into the health record. As Dr. Tompkins
is doing his visit, the billing information he enters into the system goes
into a “holding area” to be retrieved by the billing department. In the
business office, a few of those charges do not come across the interface
because of the nature of the charge.
“Probably 95 percent of the charges he submits to the
EHR are correct. We have to review and potentially modify the other five
percent to ensure that the procedures, modifiers and quantities support the
charge,” she said. She added that this is actually helpful to the
physician, because he substantiates the charge and is also educated about
what is necessary for future correct coding.
“Before, we might not have charged for a higher level
visit, because we weren’t sure if we had the documentation to support it.”
Tompkins said. “Now we are confident if audited because the EHR makes this
very clear for us by actually confirming the level of visit in regards to
documentation done.”
One other major factor in the practice’s vendor
selection process was whether the EHR offered electronic prescribing
(e-prescribing) and electronic labs (e-labs).
Even though Dr. Tompkins' practice is in Corpus
Christi, the area is more rural, so the practice asked the vendor to work
closely with the lab to get all of the systems interfaced. They chose one
lab to work with primarily. At present, about 80 percent of all results
they receive are interfaced, and they are working with other labs to
increase that number.
“Electronic labs are great. We get all the
information—nothing goes missing in the fax machine or in the mail. There
is no scanning. It’s very straightforward,” Tompkins said. Currently, the
practice generates the order (set up to look like a lab requisition) and
sends it to the lab. Then, the lab sends the results to an EHR in an area
where the physician reviews, approves and attaches the result to the
patient’s chart.
Over time, Tompkins said, they’ve worked toward
standardization in how they process this information, including using very
specific lab file names and headers. They also make sure that every staff
person places the files in the same place so that the doctor does not have
to look all over the chart for the information. They have even begun to
integrate with a few of the services they provide in the office, including
their EKG, pulmonary function test and holter monitor. Tompkins said there
is nothing like being able to have that information directly conveyed into
a patient’s chart through the use of the laptops.
Another important component of their system is the
availability of customized templates. The practice worked with the vendor
to design templates that were important to the practice. Before getting
started, the vendor asked the practice to prepare several lists, including
the 50 most-used procedure codes and the top 20 reasons for a patient
visit, which Tompkins said helped them to really feel ownership in the
product they were purchasing.
“When the doctor goes to see a patient, he has a short
list for the patient of the most frequently used diagnoses or procedures,” she
said. “It’s sort of like our frequent flyer list.” Tompkins translates the
customizable templates into a better visit for the patient, because the
doctor is able to clearly address the patient’s presenting problem with an
incredible amount of information at his disposal.
“Every time we do something, we learn a little more,
which is what propels us to move forward,” Tompkins said.
Stay tuned next
month for part two of this series, focusing on the human side of an EHR
implementation including staff training, just-in-case scenarios and staying
sane amidst all of the changes.
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