A small practice with five physicians and three nurse practitioners, Aegis Women’s Healthcare in Bloomington, Ind., decided to make the transition to an electronic health record (EHR) system. With the support of its hospital and HealthLINC—a community-based organization leading the health information exchange in southern central Indiana)— Aegis looks to realize the power of its system and improve patient care.
The American Medical Association’s Health Information Technology (Health IT) group recently asked Robert Wrenn, MD, a senior physician with Aegis, a few questions about the EHR implementation.
AMA: When did you first implement the EHR system and what prompted your decision?
Dr. Wrenn: We wanted to integrate our clinical and business processes, beginning with the billing phase about 18 months ago and the clinical phase about nine months ago. Our motivations, we thought, were fairly simple. We wanted to create legible records, to increase the accessibility of the records and to replace our billing service.
AMA: What were your expectations of the EHR system?
Dr. Wrenn: Our greatest expectation was to increase the efficiency and speed of the practice, beginning with obtaining better control of our billing and reimbursements.
AMA: What did you do to prepare for the transition?
Dr. Wrenn: We focused primarily on calculating the return on investment. The office manager estimated that the transition would take about one year and that we would not realize a return on investment for at least another year. While we were able to identify much of the cost upfront, the support and increased hardware costs were unexpected. So far, we have spent approximately $250,000. We look forward to discussing our processes—through our participation in HealthLINC—with other practices implementing EHRs. Sharing best practices—approaches to setting up wireless networks, to scanning old charts and to implementing the system overall—should help us cut costs and save time in the future.
AMA: How did you select your vendor?
Dr. Wrenn: Our office manager did the search and screen, and we interviewed three companies—ultimately deciding to go with Greenway Medical.
AMA: What were your major obstacles during implementation? What was easier or harder than you expected? What would you do differently?
Dr. Wrenn: Although we are realizing some of the benefits of the EHR system, the transition has been more challenging—bordering on painful—than we expected. The billing piece works fine, and the information gathering and sharing are works-in-progress. It is the provider piece that causes some problems. Although the Bloomington medical community has seen dramatic improvement in EHR adoption since 2003 (the percentage of providers using EHRs has grown from three to 42 percent), a number of physicians just cannot make the change to EHRs. Everyone wants to learn, but the lack of support is the biggest problem. We continue to invest in extra support, but we still have considerable ground to cover.
AMA: How are you using your EHR? Can you describe your workflow?
Dr. Wrenn: All of our billing runs through the new EHR, though we still submit a written billing statement. All of the obstetrical records are in the EHR and electronically sent to the labor room. Although it is helpful to have access to the records 24 hours a day, seven day a week, we are still standardizing our patient intake form so that it matches the layout of the EHR. Intake is easer now, but migrating our old data into the EHR system remains a challenge. Right now, we scan important documents and then facesheet the chart. This means, we must manually enter surgeries, labs and office diagnoses into the EHR. We have employed two part-time staff just for this task. We still take a pen tablet or a laptop and the old chart into the exam room. After the visit, we enter our data into the EHR and designate the paper chart for storage.
AMA: What have been your practice’s greatest clinical and operational achievements since implementation?
Dr. Wrenn: We are pleased with the billing piece and the increased access to the obstetrical records. Obtaining provider participation in the gynecology office charts is our last major hurdle. I am confident, however, that our providers will be running full speed within four months.
Our prescription process has also improved dramatically since the EHR implementation. Almost all of our prescriptions are “zeta faxed” to the pharmacy—eliminating illegible handwriting. It is also a great tracking mechanism. If a patient calls at night, the on-call physician can access the record and the prescription record—increasing patient safety and efficiency.
AMA: Do you feel your practice is maximizing your EHR system? In what ways?
Dr. Wrenn: Not yet. There are still shortcomings in our expectations about how data should populate in the EHR. Take lab data, for example. When we receive a “push” of data from the hospital, we must transfer the data into the EHR. The data is then stored as a document under “labs.” In turn, we cannot view the results in an integrated manner—in a historical chart or graph. The same is true for obstetrical records. We must scan the hospital’s obstetrical discharge information into our charts; therefore, the data does not populate our facesheet automatically. For example, when a patient gives birth, the information (e.g., date, time, etc.) from the delivery should go directly into our chart. Instead, we have to transfer that data manually, which, again, is costly and time consuming. Our vendor company is working on the challenge, but it takes time and it is costing us.
As an intermediate step, we are currently using clinical messaging—rolled out by HealthLINC in collaboration with HealthBridge, a not-for-profit HIE serving the greater Cincinnati, Ohio, tri-state area—alongside our EHR to facilitate the delivery of laboratory and radiology results and transcribed reports.
AMA: What are your future plans for health information technology in your practice?
Dr. Wrenn: We will continue to work on reaching our goals, and I am confident that we will achieve them. It is just taking longer than we anticipated. Fortunately, our hospital is extremely cooperative. Without them, we would not be as far along. Although we have considered eliminating the entire EHR system, I see the good spots. Our community will benefit greatly if we can continue to practice medicine and keep up with the costs of the EHR. But it is hard for any small practice to absorb such large costs. The cost alone often prohibits the transition. The more support provided by communities (through HIE initiatives or similar activities), state and federal governments and other stakeholders (e.g, employers, health systems, hospitals, pharmacies, pharmacy benefit managers, etc.), the more successful and timely the transition to EHRs will be.
Please send Dr. Wrenn questions or comments at hit@ama-assn.org.
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(i)The American Medical Association (AMA) does not endorse the products or services referenced in this interview posting; (ii) the views presented are those of the individual physician and not the views of the AMA; and (iii) the physician has represented that the views presented are a balanced assessment by that physician of his/her personal experience and have not been prepared at the request of or for the benefit of any third party but solely to inform other interested, similarly situated physicians.HealthLINC (formerly Bloomington E-Health Collaborative) is a community-based organization leading the HIE effort on behalf of health care stakeholders in Monroe and surrounding counties in southern central Indiana. HealthLINC and its members are partnering with HealthBridge in Cincinnati, Ohio, to share HIE infrastructure using Axolotl technology. The initial HIE effort includes clinical messaging, but HealthLINC has also developed a multi-phase roadmap with its members to advance its HIE infrastructure.
Tags: Aegis, ama, HealthLINC
