The medical community finds its way to the digital age

Although it has been slow in coming, many medical clinics and hospitals have reached the tipping point of converting from paper to electronic medical records (EMRs). In an informal survey of 13 Skagit County hospitals and clinics with at least three doctors, 38 percent have already made the leap, and of the remaining eight clinics that haven’t yet converted, more than half have plans to make the switch. Skagit Valley Medical Center (SVMC) is the farthest along of that group, and is scheduled to launch their system next year.

For SVMC it has turned out to be a long ordeal which they started over seven years ago. Dr. Mary Ramsbottom, medical director, explained in an e-mail that the delay occurred because they had to abandon their initial choice of software. “We had to stop using that product because of software problems, particularly with the growth in our organization,” she said.

Their new software choice, NextGen, will serve their entire organization including the Arlington practice that joined in 2007 and Pacific Northwest Cardiology that joined in 2008, both of which are currently using different EMR systems. Typical of the current trend for EMR software systems, NextGen also includes practice management software for scheduling and billing which SVMC expects to be operational this year.



A difficult decision


Changing over to an EMR is not a decision that can be made lightly. Organizations have to consider the initial investment in software and hardware, the indirect cost of training time, and concern themselves with issues such as patient privacy.

North Cascade Family Physicians (NCFP) decided the benefits outweighed the negatives when it chose to make the switch four years ago. And although initial cost is one of the considered negatives, it was saving money in the long run that Dr. Roger Estep, CFO for NCFP, found to be the most compelling reason to switch.

“There is an enormous amount of administrative inefficiency in the system; most people will suggest between 30 and 35 percent of all health care dollars go to the administration of the system. We can't afford that. And very quickly we're going to get to a place where we simply can't do that, and I want our practice to be moving in that area of efficiency,” he said.

Although on the surface it would seem that paper would be the least expensive option, there are hidden costs to its use.

“We were spending approximately 130,000 dollars a year in outside transcription services and that literally will go way — over the next six months that will go away,” said Pam Putney, NCFP practice administrator. She also expects that with attrition their medical records department will decrease from its current five full-time staff members. A similarly sized clinic using EMR software which they toured during their decision process had only one staff person in medical records.

She said the system will also improve patient care. “Our physicians can dial into the server from their homes, from the hospital, anywhere they might be ... they can bring that patient's chart up and see exactly what they're on, when they were last seen, what their vitals were,” Putney said. There is no transcription lag, so new entries become immediately available. The software also features built-in safe-guards, such as a warning for prescriptions that may have adverse effects in combination with a previous prescription.

Putney said they took plenty of time to evaluate which software would be the best fit for their organization, starting with a request for proposals from about 30 different vendors, then on-site presentations by the top four that they selected. Finally, Putney and Estep visited the Austin headquarters of e-MDs, their final choice.

“So after that trip, we felt, ‘Boy, this really is the right product for us,’ it took us another six months to really make the decision to purchase it,” she said. Then, another six months after the purchase in December 2007, the company went live with the software in June.



Change is never easy


Estep said that during the training he expected to work long days, and indeed, instead of a typical 11-hour day, he said he is now putting in 13 hours.

“It's pretty difficult,” he said. “The part that has really surprised me is how mentally exhausted I am.” It’s the process, he said, of retraining his 20 years of experience as a doctor, and likened it to trying to remodel a jet while in flight. “The simplest thing I do in the clinic — use my prescription pad — I now do in a completely different way,” he said.

Skagit Valley Hospital (SVH) made the change to an EMR back in 2002, but Gayle Torgerson, director of health information and management, recalled that it was a hard change for the doctors who like to have the paper charts in hand to look at. “Just the change was the major, major drawback, but it was good. It was good for our organization,” she said. And over time she feels that those who were reluctant at first now see the EMR as a benefit.

In addition to having greater efficiency and better patient care with immediate access to records, she said that the reduction in storage space has been an improvement. Record retention laws require that the hospital keep records of patients for 10 years from date of service and 21 years for a baby. “You can imagine taking it and scanning it in is a lot more efficient,” she said.

Their conversion is helping others too. “Even doctor’s offices now are hooked to our EMR where they can actually see the dictations and things, and so they don't have to call us ... they have access to it. So that's been wonderful,” Torgerson said.



More change on the horizon


Ramsbottom said one of the benefits of converting to an EMR is the potential for working with a community-wide electronic health record (EHR). EHRs differ from EMRs in scope, whereas an EMR is typically confined to one organization, EHRs unite multiple clinics, hospitals and laboratories on one system. Indeed, a group called Medical Information Network – North Sound (MINNS) has formed to start the process of creating an EHR for the Skagit area. The three hospitals involved are Island, United General and Skagit Valley Hospital. So far the group has formed a steering committee and is working on promoting awareness of the program.

Such efforts are supported by the government. In 2004, President Bush outlined the Health Information Technology Plan which proposed that by 2014, most Americans would have electronic health records. The plan is supported by grant funding to help health centers make headway on the process of converting to electronic records.

Some area clinics are holding off on converting to see what happens with MINNS. For clinics that cannot afford the initial investment of setting up their own system, it is hoped the EHR will offer a more affordable option, especially with the possibility of federal and private grants.

NCFP decided it was not content to wait. Estep said he sees real trouble on the horizon possibly five or 10 years down the road as the costs of operating a medical practice continue to go up. “As those health care dollars ultimately shrink, I’d like to remain to be able to give good primary care medicine, but the only way you're going to be able to do that is if you're efficient with the dollars that you have,” Estep said.