Case Studies regarding Medinotes
David B. Glasser, M.D.
Patapsco Eye MDs, LLC
Columbia, MD 21046
When most people decide to take a vacation, they head for the mountains and enjoy breathtaking scenery, or go to the beach and sip on a tropical beverage with an umbrella in it. Dr. David B. Glasser, an Ophthalmologist from Columbia, MD, chose to vacation at a different vacation hotspot: Club Charting Plus.
Dr. Glasser won’t argue that spending his vacation learning a new charting program may seem a bit unorthodox, but looking back, he wouldn’t do it any other way. “That time was invaluable. I can’t even begin to imagine where I would be today if I had spent that time at the beach instead of working with Charting Plus.”
Having decided to leave a large multi-specialty group practice, Dr. Glasser, along with his partner, Dr. Malin L. Howard knew that they wanted to utilize electronic health records from the day their practice opened. “Our interest in EHRs was prompted when the clinic we were with decided to start the process of researching electronic health records. We continued that process when we decided to go out on our own and after looking at several other EHRs, we chose Charting Plus,” Dr. Glasser stated. “The program had two features that we were looking for, easy customization and built in Ophthalmology content. What we were pleasantly surprised with after our purchase was MediNotes obvious commitment to training and the dedication and responsiveness of their staff.”
Knowing that both he and his partner had done their part by learning how to create and customize their own templates, Dr. Glasser turned to the MediNotes Training Department for their guidance. “Because we were starting out with an EHR, we really wanted to take advantage of that opportunity and do things right and make the best use of our time.” And it was this plan that made their implementation process as smooth as it was successful.
Prior to opening Patapsco Eye MDs in November 2004, Dr. Glasser and Dr. Howard knew that detailed and focused training would be the key to their success with Charting Plus. “Initially we purchased four days of on-site training and some additional internet training sessions that we could use on an as needed basis. Once we started looking at the program, we decided that it would be a good idea to split those on-site trainings into two separate sessions.”
The first on-site session with the MediNotes trainer had one focus, training the staff on how to best utilize and customize Charting Plus’ features. To accomplish this, no patients were seen during the first two days of the training. “The first session was really designed to introduce the software to the staff. We wanted to focus on how to best apply the software to our practice,” stated Dr. Glasser.
The second on-site training session was much more interactive. The MediNotes trainer returned for the first two days Patapsco Eye MDs went live with Charting Plus. With seven exam rooms equipped with desktop computers or mini-towers and the two physicians using Tablet PCs, the staff was ready to tackle it’s first electronic encounter note.
“We started off slowly,” explained Dr. Glasser. “For the first few days we only saw two patients per hour, but as everyone’s comfort level with the program increased, we steadily progressed to seeing four to five patients per hour and now, after nearly a year with the program, Dr. Howard and I both see 30-35 patients each day. “ And with the opening of their new clinic in November 2005, Dr. Glasser believes that with a few more staff members that they could see even more patients.
Because Dr. Glasser and Dr. Howard started using Charting Plus from day one, it is difficult to pinpoint the quantifiable benefits of the program. However, they have seen some very obvious advantages to having an EHR. “Our primary care physicians are much happier and I believe that they are sending more patients to us because of our ability to communicate with them,” begins Dr. Glasser. “We are now coding more consultative exams because our referral letters are so much simpler and we save valuable time not searching for lost charts. However, what I find most rewarding is that our patients love it! My partner and I carry Tablet PCs so we are able to have more mobility and direct interaction with our patients and still complete our encounter note by the time the patient is ready to leave the office. Our patients are amazed to find out that by the time they are done checking out, their primary care physicians will have our findings.”
After a year with Charting Plus, Dr. Glasser and his staff could not imagine having to go back to paper. In fact, after a recent issue with their sever, the staff of Patapsco Eye M.D.s had to use paper for a brief period of time and none of them could believe how much they missed Charting Plus. “It’s become a way of life for us,” states Dr. Glasser. “We had a detailed implementation plan and a dedicated staff. We spent a great deal of time up front customizing the program to our needs, but it was time well spent. We’ll see the benefits of this program for years to come.”
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As
a rheumatologist, I see some patients as frequently
as once a week at the Arthritis Institute of Long
Island®. A single patient encounter, consisting of
office notes, X-ray reports, lab results, flow
sheets and correspondence, can generate 10 to 15
pieces of paper. One patient can easily have 500
pieces of paper added to her medical chart every
year.
On
average, the practice generated 1,000 and 2,000
pieces of paper per week, and I spent two to three
hours a day dictating notes for transcription. I am
a solo practitioner, yet I had 21 full-time and
part-time employees because of the nature of my
practice.
In April 2003, I
purchased Charting Plus, an electronic medical
record (EMR) computer system by MediNotes Corp., to
minimize dictation time and decrease my dependence
on transcription. The EMR had integration
capabilities with a medical records document
management system, V-chart. Part of the reason I
purchased the EMR was the price value, along with
the ability to purchase V-chart as part of the
system. We installed the EMR in May 2003.
We
use other software products, too. PhonePad is used
for intraoffice electronic phone messaging, and
SnagIt captures the telephone printout from PhonePad
in a TIF format, which gets directly imported into
the system and becomes part of the patient’s record.
ZetaFax provides computer faxing capabilities and
integrates with Charting Plus and V-chart, allowing
us to fax directly from either program. I can speak
with another a physician about a patient’s lab tests
and fax him the lab tests from my computer while we
talk.
We
no longer mail laboratory test results or office
visit notes to physicians, but fax them directly
from V-chart, which saves us considerably on
postage. A copy of the fax is automatically saved
into the patient’s medical record for documentation
purposes. Incoming faxes are electronically received
by ZetaFax, imported into the document management
program, then electronically filed into the
patient’s chart.
Utilizing a document management system with an EMR
lets me store every piece of patient-related paper
in my computer system. I can retrieve a patient’s
entire record from a PC while seeing the patient in
any of my five examination rooms. I don’t have to
rifle through pages in a chart to find an intake
sheet, lab report or telephone message. I look at
the computer and everything is there at my
fingertips with a few mouse clicks.
Implementing the new system has changed the dynamics
of my practice, and my life, for the better.
Overall, we have decreased our administrative
payroll by about 40 percent. Together, Charting Plus
and V-chart have helped eliminate paper from my
practice; today, we are 95 percent paper-free.
One
of the biggest helps of this system is having access
to all of my patients’ records in the privacy of my
home. I installed a secure, HIPAA-compliant virtual
private network connecting my home to the office.
The secure tunnel allows me to pull up the patient’s
entire chart at home if I receive an after-hours
call from a patient. I have access to that patient’s
complete record, including his photograph, which
brings to mind his last office visit. When the
patient begins explaining the problem, I can view
his entire chart and know exactly what I am dealing
with.
The entire software
system cost less than $12,000; it paid for itself
within months and in the time it has saved me
personally. Many physicians talk about saving time
and money, but until I experienced the savings for
myself, I didn’t realize what automation could do
for me.
I
save at least two to three hours a day in dictation
time and have reduced my dictation time to 15
minutes daily. I have eliminated at least 20 hours a
week of dependence on a transcriptionist. |
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 As
published in Podiatry Management January 2004
When I
decided to automate my patient records over seven
years ago, I expected an increase in office
efficiency, but the actual achievements have gone
well beyond anything I could have ever imagined. We
grew from one full-time and one part-time doctor to
three, full-time doctors without additional support
staff. We have reduced transcription costs by at
least $25,000 every year. We are able to take
digital photographs of the patient's progress and
capture those photos in the chart. We respond to
referrals with letters that are sent even before the
patient checks out, causing primary care physicians
to visit our office to see how we can be so
efficient with no extra support staff.
All of
this has been possible because of Charting Plus, an
electronic medical record (EHR) by MediNotes
Corporation. Charting Plus is extremely affordable
and easy to use, yet its level of sophistication
provides features not found in more expensive
products.
Practice
Needed to Reduce Costs
Foot Care
Associates, P.C., is a three-doctor podiatry
practice in Hackettstown, New Jersey. We see
approximately 400 patients per week in our main
location and satellite office. In 1996, my practice
was at a crossroads. I had a part-time associate and
an increasing patient load. I had the typical one
computer office. But due to managed care and
declining reimbursements, I felt that we had hit a
point of diminishing returns. It was obvious that I
needs to reduce costs and automation seemed like the
best solution available.
The bulk
of our administrative expenses included payroll and
transcription costs. It seemed logical to address
those issues first, yet I realized that simply
cutting staff without first optimizing work
processes would adversely affect our quality of
care.
Automating our patient records with an EHR would
allow us to capture information at the point of the
care. We could document a patient visit, sign and
close the chart all at the same time, without the
time normally needed to dictate, have someone
transcribe, review the chart, edit the notes, review
the transcription, sign the chart, and so forth. In
addition, I felt that our records would be much more
secure in an electronic, rather than paper, format.
The chance of flood or fire, however remote, lurked
in the back of my mind. Losing paper records would
be devastating without having an electronic backup.
When I
installed Charting Plus, I also purchased a practice
management system for billing and scheduling. Now we
have a personal computer in every treatment room. We
make the diagnosis and enter the appropriate
information into Charting Plus during the exam.
Progress notes are completed, and referral letters
are sent electronically, all from the exam room
before patient leaves the office.
Easy to
Learn EHR
Charting
Plus is a user-friendly system that can easily
reflect your own style and workflow without a lot of
extra work on the part of the user. One of the key
features of the product is that it documents by
exception using a simple, pull-down menu method.
While I am with a patient, I can quickly click on
the chief complaint. A dialog box appears with the
relevant choices to describe that particular type of
complaint. If I want to change the templated
language to match my workflow and my dictation
methods, I just change it once, right in the exam
room, and the change is permanent.
Digital
Pictures in Patient Record
Charting
Plus allows me to document patient visits - and
their progress - with pictures. I use a digital
camera to take pictures of the patient's ailment in
the exam room. At each subsequent visit, more
pictures are taken and entered into the patient's
file. At a glance, I can see how the patient is
progressing. This cutting-edge technology has been
powerful in allowing Foot Care Associates to raise
the bar of standards in patient care.
Increased
Efficiencies and Overhead Savings
At the
time I bought Charting Plus, I invested
approximately $15,000 for hardware and $10,000 for
software. I estimate that the system paid for itself
in less than one year.
With an
automated system, the patient chart is at our
fingertips and accessible to authorized users with
the click of a mouse. Charting Plus has decreased
the time that we spend on sub-processes that are so
time-consuming and expensive, such as pulling
charts, hunting down lost charts, re-filing charts,
pasting dictation into charts ... none of that is
now necessary.
Even
though my practice continued to grow, I didn't have
to add employees for medical records maintenance.
And a conservative estimate shows that we are saving
at least $40,000 a year overall. In addition to the
$25,000 in annual transcription savings, I estimate
that we are saving $10,000 in payroll for
non-medical staff, and more than $5,000 a year for
the time we have saved in handling paper charts.
Secure
Records
It is
hard to explain the sense of well-being that
automated records have given me. There are so many
areas that are affected in a positive way by having
electronic charts. For instance, Charting Plus helps
us comply with HIPAA regulations. The security of
the program ensures that only authorized medical
personnel can access patient files, and the audit
trail tracks every change made to the patient's
medical record.
Charting
Plus also provides a powerful security measure for
disaster recovery, with a data backup feature that
you can use with an external back up device of your
choice. In our case, we use a Hewlett Packard tape
storage system that backs up our data at midnight
every day. The tapes are stored at someone's home,
away from the office.
Image of
Quality
It took
about six months to really learn Charting Plus and
get into the flow of the program. But the benefits
far outweigh the efforts. The cost savings in our
overhead alone would make it the right thing to do.
But what it has done for our image in the community
has been tremendous. The quick referral letter
responses and the reviews from patients have
resulted in a number of physicians visiting my
office to see what we are doing. That kind of
admiration is the icing on the cake.
John
Guiliana, DPM, is the managing partner of Foot Care
Associates, P.C. He is a speaker and author on
healthcare management and holds a master's degree in
healthcare management. He can be reached at
footmds@aol.com . |
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Ord, NE
Purchase Date: January 2, 2001
Roger
McCartney purchased Charting Plus
electronic medical records in
January, 2001 for his 2 doctor
optometry
practice. Although he knew
the purchase was ultimately the
right decision, he chose to wait
nearly a year to implement it. It
wasn't until the interface was
complete between Charting Plus and
RLISYS that Dr. McCartney forged
ahead with medical records in his
office. At that point there was no
looking back.
Before
buying Charting Plus, Dr. McCartney
spent nearly two years looking at
EHR systems to add to his practice.
The deciding factors turned out to
be: structured system for better
billing, flexible medical content,
ability to synchronize data between
locations, consistent/readable
records, efficient transcription
methods and an interface with RLISYS.
Charting Plus fit the bill for all
of Dr. McCartney's needs. "When you
combine RLISYS with an excellent
medical record software (Charting
Plus), it's a win-win situation. If
you already have RLI, I don't know
why you would not integrate."
The
rewards were certainly worth the
wait. The practice has eliminated
$9,000 per year in transcription
costs, eliminated one full-time
administrative position and reduced
the amount of time spent charting
after hours. McCartney's partner,
Dr. Blair said, "The work left at
the end of the day is a lot less
than before. I used to have to
prepare notes for transcription and
review transcribed documents. With
Charting Plus the notes are done by
the end of the day."
While
the system improves workflow and
office efficiency, the doctors also
feel that it helps them clinically.
"The ability to compare the findings
with the previous exam, such as IOP
and CD ratio, has been extremely
helpful. Dr. Blair utilizes the
referral letters which has cut
transcription time significantly."
Dr. McCartney stated. The
flexibility of the medical content
has allowed the doctors to create
and modify templates and exam
dialogs to their exact
specifications.
Dr.
McCartney has always used a scribe
to gather information during an
exam. This allows him to focus
entirely on the patient. He was
initially worried about bringing an
EHR into the exam room as he was
unsure how the patient would
respond. Overall both physicians
feel that patients are impressed
with their charting system. "There's
definitely a 'wow' factor with using
Charting Plus," notes Dr. Blair,
"patients feel better knowing that
we are keeping better records."
With
Charting Plus in place it is now
easier to document phone calls and
refill prescriptions. The database
allows users incredible access to
patient records. Notes are much more
complete than before and everything
is simultaneously accessible to all
of the users over the practice
network. The interface allows the
office staff to enter patients into
RLISYS, and then have the system
automatically push the demographics
to Charting Plus.
Dr.
Blair takes Charting Plus, with the
entire patient database, to their
satellite offices. While there he is
able to access and enter information
for all of the patients he sees.
When he returns he simply hooks up
to the network and synchronizes his
mobile database with the main
server. This has proven to be an
effective and reliable solution
without requiring an expensive
connection between the two offices.
Being a
Midwesterner, Dr. McCartney looked
for companies that truly valued
their customers and stood behind
their products. As a long-time user
of their practice management system,
RLISYS had won McCartney's trust
through their fair and responsive
actions. McCartney saw MediNotes as
a company that promised great
product value and reliable support
after the sale. The two systems
together are definitely creating
more than the sum of the parts for
this optometric office.
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Eye
Care & Surgery Center of New Jersey
Warren, NJ
Purchase Date: November 21, 2000
As seen
in Health Management Technology,
August 2003
Advanced Eye Care of New Jersey has
not created a paper chart in over
two years even though we see about
3,500 new patients a year. Our
records are completely legible and
instantly accessible to authorized
users with the click of a mouse. We
have no more filing. We write
prescriptions electronically. We
have increased sales of our optical
products by 25%. We don't use
transcriptionists anymore. We are a
completely paperless office and we
did it by implementing Charting
Plus, a sophisticated, yet
easy-to-use electronic medical
record by MediNotes.
The
entire project did involve time and
capital and a commitment on the part
of the physicians to use the system.
However, the system was extremely
easy to learn and we have been able
to customize it to suit our exact
workflow on an "as-we-go" basis. We
have five physicians and three
locations, with over 20,000 patient
visits per year. Since implementing
Charting Plus, we have noticed
phenomenal results in terms of time
and cost savings as well as
increased revenues.
A
20-Year Dream
In the mid-1980's, I saw an EHR
system for the first time and
dreamed of creating a paperless
environment in my own ophthalmology
practice. In 1998 I installed a
system, but the inflexibility of
that software and its database
foundation were not functional for
this practice. When I later saw a
demonstration of Charting Plus, I
realized it was exactly what I had
been looking for. I purchased and
installed the system in 2001.
Charting Plus was interfaced with
Medical Manager, our practice
management system. We have installed
three servers with Windows 2000 for
Charting Plus. A terminal server has
been added to help with our digital
angiography. These are all
interconnected via routers and hubs
and T1 lines between our main office
and satellite locations.
We have
experienced important, positive
changes within our offices since
implementing Charting Plus. Some
changes were expected, and some have
been pleasant surprises and welcome
enhancements to our office
efficiencies and processes.
Increased Sales and Savings
Since implementing the system, sales
in our optical shops have increased
by 25%. I attribute this to the
location of our optical shop and our
electronic prescription writing
through MediNotes. In each location,
our optical shop is located at the
entrance of the main reception area.
When a patient signs out, the
patient's prescription is routed
directly to the optical shop, making
it easier for the patient to stop
there and start a conversation with
our optical technician.
Prior
to implementing the EHR, each
physician had an assistant that
transcribed everything. With
Charting Plus, we were able to
reduce our staff by five full-time
positions. Now, either the physician
or the assistant enters encounter
information into the patient's chart
during the exam. At the end of the
visit, the physician reviews the
information for accuracy, signs the
note and closes the chart. No
further back-end work is necessary
to complete the encounter. I
estimate that we are saving at least
$125,000 a year (not including
benefits) on transcriptions and the
salaries of five people following
our physicians around writing notes.
And existing staff members have
better of use their time.
There
is no more filing. As a result, we
are saving at least $2 per patient
chart. Assuming we touched half of
our patient records only once, we
would be saving $20,000. How many
times do we file and refile and
refile a chart? In reality, that
savings alone can add up to
substantial dollars every year.
Flexible System Matches Our Style
Charting Plus is flexible and can
support the method of documentation
used by each physician within a
practice, which has allowed all of
us to continue with our own data
capture methods and terminology.
I like
learning about and using new
technology, and I developed macros
for the descriptive portions of
patient visits that were previously
typed or written repeatedly. But for
my colleagues who were less
enthusiastic about using a computer,
they found the system to be as
simple as selecting a phrase from a
drop-down menu and clicking on that
box. The proper terminology was
incorporated into the patient
record.
One of
the key features of this system for
me is that it can be as simple - or
as advanced - as you want it to be.
For example, we use digital
angiography to capture images of the
patient's eye. The fluoroscein
testing is done on a separate piece
of medical equipment, but the images
are automatically linked to the
patient's record through Charting
Plus. In addition to fluoroscein
angiographies, we scan in operative
reports, surgery consents,
topographies, visual fields, retina
tomographs, and pathology reports.
All of this information can be
retrieved within the electronic
patient record and accessible with
the click of a mouse. We don't have
to pay a staff person to search for
these reports in a paper file.
The
majority of our pediatric
ophthalmologist's caseload involves
consultations. With the electronic
capture of the information, letters
and reports to referring doctors can
be expedited and submitted in a more
efficient and timely manner. We have
received compliments from referring
doctors about the timeliness of our
reports to them.
Easy
Access to Secure Records
We no longer have any wait time for
patient records. Information is
accessible in real-time to multiple
users simultaneously throughout our
offices. From any location,
authorized users can instantly view
information without leaving their
workstations. This is especially
important to us since we have more
than one location. Charts aren't
moved physically from location to
location anymore, previously a
costly and tedious process that
often resulted in physicians waiting
for key information.
With
HIPAA compliance an issue now, we
were concerned about transfer charts
and having a paper chart lying
around the office. Charting Plus is
certified HIPAA-compliant. And with
all of our information stored in a
secure, centralized electronic
location, as well as a written audit
trail of who has accessed a chart,
we feel confident about our HIPAA
compliance.
Enhanced Claims Processing
Rapid access to patient information
means less days in Accounts
Receivable for our practice. Our
revenue is captured quickly and
completely, and claims are billed on
the day the patient is seen. Our
normal level of A/R days outstanding
for the practice is in the low 30s,
compared to a national average in
the high 50s.
Many
insurance companies request
photographic information for
additional documentation before
claims payment is released.
Previously, charts had to be
retrieved, copied and submitted to
the insurance companies. With
Charting Plus, the information can
be retrieved and submitted
electronically, resulting in less
work and quicker payments.
I'll
Never Go Back to Paper
Choosing Charting Plus was one of
the best decisions I've ever made
about my practice. We have achieved
our objectives and created a truly
paperless office. My dream is now a
reality -- I no longer have charts
stacked on my desk. I feel more in
control and have a great sense of
accomplishment. Colleagues and
patient are astounded by how modern,
efficient and smooth our operations
are. Our staff and physicians are
thrilled with the system, and I will
never go back to paper. |
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