Walk into the practice of family physician John Wilson, MD, in Daly City, CA, and you’ll notice something unusual: It’s a tiny space. Wilson uses just half of a 1,000-square-foot office for his solo practice, which includes one nurse practitioner/physician assistant, one medical assistant, and no office manager, in part because he’s a member of the Brown & Toland IPA
, but mostly because electronic health records and other information technology have pumped up efficiency.
“The EHR keeps me very efficient,” Wilson says. “I can manage a lot of things with it,” including clinical notes, problem sheets, prescriptions, and schedules for a patient base of more than 2,000. Thanks to the EHR, Wilson makes a living despite practicing only half the time. “It allowed me to feel comfortable taking that extra time off ,” Wilson says. He can log in from home to read results or check secure, electronic messages from other clinicians in his practice or within the IPA. He permits e-mail communication with patients who have signed a waiver indicating that they are aware that standard e-mail is not secure. “It helps me do my documentation,” Wilson says.
With the EHR, Wilson doesn’t need a big file room. “I go to the trouble of printing my progress notes and putting them in the chart because I like to have something to refer to when I’m in with a patient,” Wilson says. “Otherwise, I don’t really need a paper chart.” Wilson also loves that chart pulls are a thing of the past.
When Wilson opened his practice in 2002, he had a Millbrook electronic scheduling and billing system (GE has since acquired Millbrook). He migrated to Allscripts
software for practice management, and, at the beginning of 2007, farmed out billing services to Brown & Toland, further reducing his workload. A MedPlexus EHR
was installed in 2004. At the time, Wilson took his old paper charts and scanned them to reduce the amount of paper in the office. “The quality of my progress notes is way better,” he says. He also has become “compulsive” about keeping medication lists up to date. “I never really did interaction checking before [the EHR] unless the patient had a long list of meds.”
Wilson’s experience is characteristic of wired physicians, who have wholeheartedly embraced IT as a means toward delivering better care for less money. Another commonality among high-tech doctors is that they keep sane working hours. “Our office is a ghost town at 5:15,” says James R. Morrow, MD, of North Fulton Family Medicine
, a practice with 10 physicians and 10 PAs at four suburban Atlanta locations. The practice won the 2004 Davies Award for primary care, a prestigious honor from the Healthcare Information and Management Systems Society
(HIMSS), and Morrow himself was named 2006 HIMSS Physician IT Leader of the Year.Rise and Shine
Sure, they do start early, with PAs in the office at 7:15am to handle walk-in patients—the physicians generally arrive an hour later—but nobody rushes. The average provider sees 28 to 32 patients a day. And by midday, physicians usually don’t have to choke down a sandwich while filling out clinical notes. “It’s a nice, leisurely lunch,” Morrow reports. “With each of the patients, all the documentation is complete [by the time they leave].”
Charge-capture technology at the point of care sends bills directly to the practice management system, and that has helped boost revenue. “The coding thing is very good,” Morrow says. Indeed, he reports that the practice has the documentation to support an average code of 99214 for established patients. “Now it’s so much easier to document the work we do.”
The extra room reclaimed by virtue of not having to store paper charts has enabled North Fulton Family Medicine to add ancillary services, including bone-density screening. The practice also recently got computerized x-ray equipment, eliminating film, and there is no more scrambling between locations to find images. It was an expensive proposition, but Morrow believes it will pay for itself in short order. Most of the documentation at North Fulton Family Medicine is template-based, and Morrow has no problem with that. “It’s no different than dictating, ‘50-year-old female, physical,’ then having a transcriptionist type the dictation,” he says. In fact, the practice financed the entire EHR project by eliminating transcription expenses.