Physicians go paperless
While federal officials this year adopted a carrot and stick approach to move physicians and hospitals into electronic recordkeeping, some physician groups in Westchester County have not waited to be prodded with stimulus-package financial incentives and the threat of reduced Medicare payments for those who fail to make the change from paper to digital by 2015.
The county”™s two largest multispecialty practices, Mount Kisco Medical Group and WESTMED Medical Group, have been well ahead of what will be a crowded field of transitioning health care professionals over the next few years. The approximately 190-physician Mount Kisco group introduced an electronic medical record, or EMR, in 1998. The EMR has been the official record of patient care at MKMG for about three years.
WESTMED, an approximately 150-physican practice formerly known as the Westchester Medical Group, has used an EMR since 2002, according to a technology spokesperson for the group. Over the last seven years, the practice has saved more than $500,000 per year in transcription costs with the change. The number of full-time equivalent employees for each physician has been reduced from five to 3.2, an annual savings of more than $6 million.
At ENT and Allergy Associates L.L.P. (ENTA) in Tarrytown, CEO Robert Glazer is leading a phased approach to EMR conversion for the 102-physician group”™s 30 offices in New York and New Jersey. The company has implemented EMR at 12 sites in the past year, he said.
“We”™re implementing at one or two locations every six or seven weeks right now,” Glazer said. “I will be fully paperless by the end of 2010.”
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ENTA currently is testing software at its New Rochelle and Purchase offices for a new Web portal for patients expected to launch by the end of 2010. Patients will be able to do their medical and insurance paperwork from their home computer and eventually make appointments and receive test results online.
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“It is, I believe, going to really change the flow,” Glazer said. “It”™s redirecting the office flow and the patient flow.”
Committing to the EMR changeover three years ago, ENTA staff sampled 12 different products before choosing software best suited for its ear, nose and throat and allergy specialists. Still, as other physicians and health care professionals have found, the selected software often needs more tweaking and customizing to suit a particular practice or organization.
At ENTA, templates must be designed to accord with physicians”™ thought processes during diagnosis and treatment, Glazer said. “It took us a year and a half to get where we are and we”™re still redesigning,” he said.
In that time, Glazer has increased ENTA”™s information technology staff by 2 1/2 full-time positions. He created what he calls “our EMR SWAT team,” a full-time crew of five employees headed by the company”™s regulatory affairs director, Katie Owens, that develops instructional materials and training programs and trains physicians and ENTA”™s 525 employees in EMR protocol. The SWAT team spends six weeks at an office implementing the new technology, “There is a slightly painful learning curve,” said Irene Yu, an ENT specialist using EMR at the group”™s New Rochelle and Purchase offices. Yu is still adjusting to interacting with a computer ”“ she prefers a desktop screen to the hand-held tablet commonly used with EMR ”“ and filling in precise medical templates while seeing a patient. With EMR, “It has to be accurate, it”™s not just something that you scribble,” she said.
Eliminating physicians”™ notoriously illegible handwriting is a commonly cited benefit of electronic recordkeeping. “It”™s pretty much proven that EMRs by their nature will reduce errors because there”™s much more clarity in the documentation,” Glazer said. That in turn lowers the risk of medical malpractice suits for ENTA, which this year became self-insured for malpractice.
“One of the biggest issues for medical malpractice is failure to diagnose,” he said. “This is really going to go a long way to helping that.” The EMR gives physicians daily updates on lab testes ordered and lists a patient”™s medications, warning doctors of possibly dangerous drug combinations. It also calculates recommended billing codes that can be changed by the physician.
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“This really provides a great time management tool as well as a way to reduce errors,” said Glazer.
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Going electronic in medical offices can be daunting. “This is a huge project,” Glazer said. “It”™s very costly. Beyond that, it”™s time-consuming. You need a skill set that most physicians don”™t have the time for.”
The CEO said ENTA will invest $4 million to fully implement its EMR. The group practice will recoup that cost in federal incentive payments to physicians who adopt certified EMR technology. The payments, an element of the American Recovery and Reinvestment Act, will start in 2011 and be paid over five years to a maximum of $44,000 for an eligible physician. “I believe over time this thing pays itself off,” said Glazer. ENTA will eliminate all or almost all of its transcription costs that amount to about $400,000 a year and save too on costly document scanning for patient bills while speeding up cash flow.
“Sure it”™s going to cost some money, but over time it”™s going to save more money and it”™s going to save our physicians and our patients. ”¦This is just Business 101 ”“ what”™s good for business and our patients.”
“I think ultimately where this all goes to is portability of medical information between practices” such as ENTA and Mount Kisco Medical Group and between different electronic medical record systems, he said.
“This is a cottage industry. Most physicians are still on paper charts,” Glazer said.
Those who stay on paper charts by 2015 will be penalized with a 1 percent decrease in their Medicare reimbursements by the U.S. Department of Health and Human Services. The physician penalty will rise 1 percent each year and could reach a maximum 5 percent in 2019 and beyond if 75 percent of the nation”™s physicians treating Medicare patients do not adopt EMR by 2018.
“This issue of EMR is going to be a huge economic stimulus throughout this area because of the resources you have to bring to the table to implement this,” Glazer said. “It has trickling effects all over the place.”
At ENTA, “We”™ve gotten this now to the point where the roll-outs are much easier. The feedback is better”¦Those physicians who have embraced it, love it. We”™ll continue to fine-tune it.”
“This is the hardest thing I”™ve done, but it”™s the most gratifying,” he said.