What should you keep in mind when choosing and using an electronic medical records and billing system? To share voices of experience, we talked with healthcare professionals who have been through the decision-making and implementation process, and who now work with a digital system every day.
Our panel:
Dr. Mary Margaret Crestani chose electronic medical records and billing for both her family practice office and for Apollo Urgent Care Center in Huntsville. She started with electronic records just out of residency when she joined a partnership, then switched to a system that was more convenient to use when she opened her individual practice.
Dr. Ramann Nallamala specializes in internal medicine at the Huntsville Clinic. He started with an off-the-shelf medical notes system five years ago and soon upgraded to a system with full digital information management capabilities.
What are some of the advantages you hoped to achieve in going to a digital office? Have the benefits been what you hoped they would be?
Nallamala: “It saves me a tremendous amount of time and money. I’d need one to two more people to handle the same work on paper. I also have a record of every patient encounter in front of me — every office visit, pharmacy request, lab report, and surgical and hospital records.”
Crestani: “Legibility is also an advantage. I can fax a prescription while I’m with the patient, and I don’t get a call from the pharmacy asking me about a word. My notes are easily legible. I have better documentation in less time, so it helps us get better reimbursement. And we don’t have to waste a lot of time looking to see who has a file. We can all access it.”
Each of you uses a different system than you started with. Why did you switch?
Newbell: “I initially got a low-end software package thinking I was saving money. I forgot the old wisdom that you get what you pay for. It required two other programs to get it to communicate with our billing software which was yet another program.”
Crestani: “I wanted a scheduling and billing system that was less cumbersome to use, and more efficient document management. With my new system, it’s easier to scan in outside documents, fax prescriptions and communicate with labs, other doctors and hospitals.”
Nallamala: “I needed more capabilities. My new system handles the complete flow of paperwork and patients, from scheduling and appointments to tracking every patient encounter, to billing. We can fax and receive referrals, home health care forms and reports directly within the system.”
What are some of the key points you’d advise another physician or administrator to consider in choosing a vendor?
Crestani: “You know what you’ll need in the exam room, but your practice administrator and your billing and scheduling staff are likely to have a clearer sense of the capabilities they will need. Ask them to test vendor demos and give you their opinions. If you’re accustomed to dictating, you’ll need a system that can accept dictation. If you’re not a fast typist, drop-down menus are helpful. If you want to type in information, you’ll need one that allows free text. A templating feature can also be helpful.”
Newbell: “Tech support and flexibility of data entry are important. Some things lend themselves well to templates, and others don’t. Records and billing should be as integrated as possible. As the practitioner enters diagnoses and procedures, the system should automatically in-put the corresponding ICD and CPT codes for billing.”
Nallamala: “I’d recommend having your own server rather than using an online service. If your Internet service goes down, you won’t have access. Your data is yours, and you have access to it if you need to move it to another system.”
In moving from paper to digital, how can you make the transition process easier?
Crestani: “It’s important to take the time to set the system up the way you need it. If you don’t, it’s hard to find the time later. You won’t like it, and won’t use it, so you’ll lose the advantages. It’s good to have someone to answer questions the first couple of days, and to save some of your training for after you’ve used the system so you can ask better questions. You also need to check compatibility with labs and others you exchange data with. If you get your software from one vendor and your equipment from another, make sure you’re clear on compatibility and who to go to if you have a problem.”
Newbell: “Everyone needs to be prepared for the learning curve phase. Don’t just put old files under ‘old files.’ Put old labs under ‘labs’ and referrals under ‘referrals.’ That means transition time, but it’s worth it.”
Nallamala: “We used a high-speed scanner and in-put records into each chart as patients came in. It’s worth the time and money when you get it in the system.”
What about backups and security to protect data?
Crestani: “Every user has an ID and password, and if a workstation is unattended, the system automatically turns the screen off and locks it.”
Newbell: “If we came to the office and found a smoldering crater, we would still have over 10,000 patient charts and years of billing records. We once lost some data due to an anomaly with a memory upgrade, but were able to completely restore it from a backup.”
Nallamala: “We do tape backups every night and take them off-site for security.”
Now that you’ve worked with electronic systems awhile, would you ever consider going back to paper files?
Crestani: “I love electronic records, and my staff loves it. It may take awhile to get used to it, but three months later, they’ll say, ‘Don’t take our digital system away!’”
Newbell: “If you get a good system with good tech support, you’ll wonder how you ever lived without it.”
Nallamala: “I’ll never have to pull another paper chart again!”
September 2007
