Continued
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“We could be the most automated practice in the area if we so chose,” LaSalle says. He has since installed a lab interface component. The menu of
add-on options is another point to consider in evaluating different systems.
For LaSalle and his partners, automation was less a means of reducing staff than
a way of using existing employees to bring in additional revenue. For example,
a former full-time filing person can now spend 75 percent of her time
concentrating on collections. The easy record keeping can track minute details.
“Now you can begin to actually understand at the end of a month that you only
gave 50 flu shots when you have the potential to give 200,” LaSalle says, “or maybe you evaluated 50 of your patients for lipid abnormalities when there
were 1,000 that you could have the potential to do.”
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Ensuring success
One of the most crucial parts of any office automation, LaSalle says, is the
quality of billing software. When submitting bills to third-party payers, “make sure all the t’s are crossed and the i’s are dotted. There’s no room for a wrong dot or a wrong space or a lack of patient ID number.” He cringes at the memory of waiting almost four months on as much as $150,000
in claims. “We were looking at borrowing money to stay afloat.” He recommends a dry run for the implementation of sending insurance forms. “The system should be perfect before (a physician) ever tries to get involved
with third-party payers,” he says.
In Lockwood’s experience one of the most daunting tasks in the switch from paper to
electronic records is entering data from old charts. “You should explore alternatives to doing it yourself,” he says. “Hiring an assistant might be cheaper in the long run when you consider the cost
of time that could be spent with patients.” Remember, too, that you probably want to transfer only the most critical
elements of a patient’s chart, not every lab, progress note, or benign ER visit.
For do-it-yourselfers, Waldren at the AAFP suggests a step-by-step approach. “You can’t expect to come in Monday morning and say, ‘We’re going to use the EMR on all patients for everything, and we scanned all our
records over the weekend or paid somebody to do that.’ It’s better to go slow and steady and get used to the system.”
Waldren says, “For the first two weeks or months start with a nice, basic EMR application, such
as entering meds and e-prescriptions for all patients. Or, pick a special
population, such as diabetics, and work that into the electronic document. Then
well-woman exams, then student exams, then male physicals, and so on. The first
couple of steps are baby steps, but very quickly you are up and running, and
the next thing you can add quite quickly.”
That’s contrary to the advise of many experts, who favor a “head-first dive” into EMR. Everyone going through the same processes at the same time allows for
group learning, support, maximum use of on-site system support, and doesn’t permit any techno-phobic stragglers.
While totally committed to an EMR, Christopher Flores, MD, in Rancho Mirage,
California, has sidestepped one headache. “We are completely out-of-network to all insurance and Medicare. Patients pay
fees with cash, credit card, check, or debit card and can submit claims for lab
work and other subsidiary services. This eliminates the need for billing
software.”
Flores also opted for a consultant, on retainer, to assemble his electronic
setup. “It’s one of the best things we’ve done,” according to his wife, Marciela Fernandez, who works with him. “When you look at what you pay out for other things, such as supplies, we don’t pay him an exorbitant fee. (Without him) it could cost thousands and thousands
of dollars to recover lost data,” she says.
Flores is pleased with his decision to go solo. After 18 years in “different types of environments, usually as an employee physician, I found I
couldn’t do what I do what I was trained to do. I couldn’t provide the type of service, and quality that was the reason I went into
medicine in the first place. I figured the only way I could do it was to do it
myself,” Flores says. “Maricela, an attorney, wanted to try something different, so we’re working together, just the two of us.”
He says that, because of low overhead, “two people still can handle 600 to 700 patients, meet their needs, and be timely
and personal. I only have to see eight patients a day to be successful, whereas
most doctors’ offices have to see at least three times as many, and the phones are ringing
off the hook [with patients who want to join his practice].” In October 2005, Flores found a space of 1,000 square feet that includes an
office with a relaxing desert view which he uses to interview patients and can
double as a second exam room.
His initial $20,000 outlay included one scanner (he now has two), fax, printer,
copier, two desktops, and a laptop. He selected SOAPWARE EMR, “mainly because it was one of the lower-cost programs with a good reputation.” Also part of the package: a server, used for computer and data storage, and
four hard drives with 80 gigabytes which constantly back themselves up. “They call it a redundant array,” Flores says. The server has a metal tape backup, because Flores and Fernandez
are “very, very aware that if you lose your medical records, you really are in hot
water.” Once a week Fernandez removes a tape, backs it up, and takes it off-site for
secure storage.
Flores also customized his EMR, which is a universal option, with key phrases
that he uses repeatedly, saving him hours of data entry. With a few keystrokes,
he can generate whole paragraphs. “For instance,” he says, “if I write ‘ALERT,’ and hit a base key, it fills in the rest: ‘Patient alert and oriented, aware, can answer all my questions, doesn’t look depressed, etc.’ It saves an endless amount of valuable time.”
Two desktops are now networked into his server. Flores uses a wireless laptop in
his exam room, where he can type prescriptions and referrals and send them to
Fernandez, who faxes them from her computer. More recently, they purchased
headsets. One patient, a 70-year-old woman who asked Flores for a donation to
support her participation in a charity run, was amazed at the magic of it all.
Talking into his headset, Flores told Fernandez to cut a check. By the time the
patient left, both her bill and a check were waiting.
While some physicians have tried and given up on solo practices because of low
profitability or for other reasons, many physicians report full practices with
waiting lists. The AAFP’s Waldren says, “It’s not an easy decision to go ahead and bite the bullet. It takes time, energy,
effort, and commitment to make it successful, but I think most physicians will
see significant rewards
if they stick to it.” END
Eileen Lockwood is a freelance writer based in St. Joseph, Missouri.
