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Chartless in Memphis

September 1, 2006
by John Vines
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Campbell Clinic Orthopaedics embraced an EHR to escape paper-based patient charting.

With four locations, 39 physicians, 42 physical therapists/physical therapists assistants/certified athletic trainers, 40 physician residents, more than 350 employees, and over 9,000 clinic visits each month, Campbell Clinic Orthopaedics recognized that it might be time to move to an electronic health record (EHR) and away from the traditional paper patient chart system.

Recognizing the goal and reaching it, however, was not a simple path. Despite the government and media hype about EHRs, Campbell Clinic leadership was keenly aware of the reality that about half of all such installations fail.

We wanted a chartless office with electronic access to patient information... and we wanted to succeed on the first attempt. The bottom line was to identify and implement a viable technology solution to digitize patient records without disrupting the way our providers practice medicine.

Do We Really Need an EHR?

As our search team began to preview EHRs through vendor presentations followed by site visits, it was immediately apparent that many of the products would seriously slow down the pace of our clinic. We were seeking office efficiencies, and even in the short term, we certainly did not want to sacrifice physician productivity and patient volume. The processes with many of the EHR software products seemed time-consuming and required extensive data capture that detracted from direct patient care.

Recognizing that the "wish lists" of our physicians varied from modest to lavish, we could not afford to be wooed by the bells and whistles of the feature-rich EHRs in the market today or delay implementation or risk failure as physicians learned to adapt to these robust systems.John vines

All these issues were carefully considered before we made our final decision and purchase. We assessed the practice's immediate needs and sought a solution that would satisfy those needs, interface with existing software and upgrades, and grow with the practice. We finally chose Montvale, N.J.-based SRS Software's Freedom Chart Manager, an enterprise document management and business workflow solution specifically designed for healthcare.

Implementation: Careful Planning and a Good Team Ease Angst and Anxiety

To facilitate the conversion from paper charts to digital charts, a new main server and backup servers for each of the three satellite offices were purchased. High-speed scanners and bar code label printers were also purchased and installed throughout the practice. The clinic had recently upgraded to digital radiography, which resulted in tablets for physicians and monitors in the dictation areas. These additions also supported the latest conversion.

Once the requisite hardware and software were installed, implementation was undoubtedly the next challenge. Collaborating with the vendor's service staff, we planned the roll-out — identifying the order in which each physician would enter the implementation process. We allocated staff to scan all paper documents into the new system for scheduled patients of those physicians who were being phased in first.

Keeping pace with the demanding schedule, our office team scanned charts for each physician for a four-week period prior to the go-live date. Emergency or unscheduled appointments were handled on an "as-needed" basis. Yes, there was a bit of anxiety from some of the staff as we faced change and new technology, but as the implementation progressed, everyone was pleased at how the process unfolded.

Going Solo: Taking off the Training Wheels

Ease of use and training were serious considerations when we were making our software purchase decision.

We required a technology solution that could be readily accepted by a wide array of users who had varying degrees of computer skills and knowledge. The software had to improve our efficiency throughout the enterprise, not impede it. There is no "down time" at Campbell Clinic. We could not close our doors for a protracted period of time while the majority of employees learned to use a new system. One of the key selling points of the new technology was its ease of use: Training was minimal — less than half an hour for physicians and slightly longer for office staff.

The selection of a document management and business workflow solution designed for healthcare was a deliberate technology decision on our part to avoid the pitfalls of EHR products often experienced by our colleagues: Slowing down physicians, causing frustration, and compelling physicians to be data-entry clerks — forfeiting overall productivity, which impacts the bottom line.

Impacting Every Aspect of the Practice

While some EHRs end up as high-tech toys, our document management solution has a far-reaching impact on the daily operations of our busy practice. Every aspect of the clinic is affected by the purchase, and that is why our choice had to be a technology that could be readily used by all staff members.

Workflow efficiencies free staff time and enhance the level of patient services throughout the practice. Immediate access to patient charts allows staff — both office and medical — to take patient calls in a timely fashion and be educated in their communication with those patients. A more efficient, smoother workflow significantly impacts the tenor of the entire office. Staff and physicians alike have more time to spend with the patients, instead of hunting for charts in a paper system.