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Soul Road: One Solo Doc’s Extensive EMR Journey

January 28, 2014
by Gabriel Perna
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A Q&A on EMR implementation from solo pediatrician Galen Chock, M.D.

When it comes to health information technology (HIT) adoption, solo practitioners have it a lot tougher than their colleagues in larger practices.

This isn’t advocate-driven conjecture, it’s a fact. Recently, researchers at the Commonwealth Fund, the Washington, D.C.-based nonprofit, released a study that said as much.  Looking at data from the 2012 and 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, the researchers found that half of physicians in solo practices use electronic medical records (EMRs), compared with 90 percent of those in practices with 20 or more physicians.

The challenges solo practitioners deal with in implementing HIT are obvious and undeniable. There is, of course, the matter of cost, both in maintenance and upfront expenditures. Furthermore, small staffs mean a reduced level of support from a clinical, administrative, and technical standpoint. And as Galen Chock, M.D., a pediatrician in Honolulu, says, “When it comes to implementing HIT, support makes a big difference.”

Dr. Chock would know about having to overcome these obstacles. As the solo practitioner explains in an interview with Healthcare Informatics Senior Editor Gabriel Perna, his own EMR implementation journey was fraught with failure and frustration, and ultimately, success. The two recently talked about this journey, how he has been able to optimize his EMR and thrive where other solo docs have struggled.

Below are excerpts from that interview.

Galen Chock, M.D.

When did you start on your journey to implement an EHR?

I started practicing in 1982. When I started, it was paper charts. You just wrote things in. About five years into practice, because pediatrics has a lot of volume, my handwriting was deteriorating and I figured I had to do something better. We went initially to Word Perfect, then Microsoft Word, and we started building word templates. I’d see the patient, I’d type up a note, and we’d glue it in the patient chart. I was fine with doing that for 10 years.

Sometime in 2009, I was here one evening finishing my notes, and I figured there had to be a better way of doing things. At the time, our HMSA (Hawaii Medical Service Association), the Blue Cross and Blue Shield here, was offering a financial incentive to [implement] an EMR. Originally, I was okay with sticking with the word templates and gluing them into the chart. At some point I did some research, and right before the end of that incentive, I changed my mind and figured we should go to an EMR.

We went with a company called MedeNotes, because I heard that it was a good program for pediatrics. It also turned out one of the local practice management companies was supporting it. So I thought that was an ideal world, an EMR built by a company on the main land, but had local support here in Hawaii that could help me with any bugs. We went with that at the end of 2009 and it was tough. You had to build a lot of templates that were not that intuitive. Even though I was used to word templates, it took a lot of time.

Low and behold, within six months, it got bought out by another company [Editor’s note: In 2008, MedeNotes was bought by Eclipsys]. That company said [to me], “You should transition to a better EMR.” Fortunately, I did not. I stuck with [what I had] and then about a year later, that company also got bought [Editor’s note: In 2010, Eclipsys was bought by Allscripts]. The newer company said the same thing. “You have to move to the better EMR.” At that point, I said, “Maybe I do need to move to a better EMR, but let me look around.” Fortunately, I had seen Amazing Charts (North Kingstown, R.I.-based EMR vendor) in the past. I thought about it. I was concerned about not having local support. I tried a free download and tried it for six months. I decided to go with them in the summer of 2011.

What made you go this route?

I think the biggest thing; the reviews were excellent on Amazing Charts. It’s hard to find reviews on EMRs, but whatever I did find on it, it was always 4-5 out of five stars. That was one. Two, they allowed me to download the program and use it without paying for it, which no other EMR did. I learned from the last one, you can look at it all you want, but you don’t know until you use it. Thirdly, it was affordable. I’m a solo practitioners, I had already spent money on an EMR. If I’m going to another one, I had to be conscious how much I was going to spend for an EMR. Also, it was a stable enough program that I myself could load it into a server and get it into my work stations without much difficulty.

I’m a solo practitioners, I had already spent money on an EMR. If I’m going to another one, I had to be conscious how much I was going to spend for an EMR.

What are some of the ways you’ve optimized your EMR to cater to your needs as a solo practitioner?


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