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.
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.
Our document management solution has improved the general workflow of the entire practice, increasing efficiency and making many daily tasks more convenient. A quick overview reveals how often and how many staff members typically "touch" a patient's electronic chart:
Physicians/physical therapists — providers record details of the patient visit without deviating from the way they saw patients or documented visits in the past, i.e., dictated and transcribed, handwritten or templated on worksheets;
Nurses/physician assistants — medications, tests and follow-up instructions are entered into the digital chart and can be readily accessed in response to a patient's call, a pharmacist's question, or a referring physician's inquiry;
Medical records — information, such as referral updates, test results, operative reports, x-rays and patient health history updates are digitized as part of the electronic chart;
Business staff — having a digital chart "on demand" (in contrast to submitting a request form and waiting a day or two before a paper chart appears) allows staff to process claims at once or check exam notes or an operative report on screen for an immediate resolution to an EOB, claim or coding question; and
Reception — all insurance cards are scanned directly into the system at check-in.
Room for Growth
Critical factors with any healthcare technology purchase are its immediate influence on the practice and its ongoing impact. Can the solution grow with the practice? What are the immediate/first-year savings and costs? Are there recurring savings and costs?
While there are many intangible savings with our purchase — increased office efficiency, improved response time for patients with clinical questions, greater access of patient information for physicians and staff, etc. — the operating cost savings for the first year of implementation and the projected operating cost savings over a five-year period speak volumes about our decision:
Considerable salary/benefits savings with the elimination of 4.8 employees in the medical records department through attrition because of the new efficiencies within five months of going live;
Reduction in costs for courier expenses, offsite chart storage, and chart supplies;
Elimination of microfilm costs; and
Projected savings multiply over the long term, as Campbell Clinic expands.
While more than half of EHR installations fail, Campbell Clinic was successful because we carefully analyzed our needs, sought out a technology solution that seamlessly interfaced with existing programs yet could grow as the practice expanded, and minimized our financial risk by opting for a document management and business workflow solution that met the rigors of today's healthcare environment. It has demonstrated strong operating cost savings that could quickly pay for itself.
John Vines is CEO of Campbell Clinic Orthopaedics, a healthcare organization with four clinics in the Memphis, Tenn., area.