Electronic Medical Records

Goodbye to Paper
Electronic Medical Records Streamline Record Keeping

Twenty-first century medical technologies not only speed diagnoses, but they also minimize the invasiveness and maximize the comfort of treatments. Technological advances also promise to tackle a great challenge in health care: the elimination of what sometimes seems like an endless stream of paper.

It is true that transition from paper to electronic records involves much more than plug-and-go technology. Moreover, training medical professionals and transferring existing records take time.

However, KSF Orthopaedic Center is committed to the investment necessary for full implementation of electronic medical records (EMRs), says Michael Berkowitz, Clinic Administrator for the group. Patient care, internal efficiency, and simplicity in billing are all enhanced by EMRs, he explains.

Indeed, the U.S. Department of Health and Human Services (HHS) sees the move to EMRs as a significant way to reduce the cost of providing the highest quality health care to all. By removing links in the chain that accompany paper records — transcription, filing, and storage — information moves faster and more easily.

HHS and related federal agencies, such as the Centers for Disease Control and
Prevention (CDC), also point to the important capacity EMRs have to help reduce medical errors. The fewer steps in any process, the more remote the chance of a mistake.

For example, by ordering prescriptions electronically instead of using a pad and pen, a physician can send a request directly to the pharmacy. At the same time, EMR systems can compare a drug order against standard dosages and send alerts to a prescribing physician regarding patient allergies or drug interactions.

The adoption of EMRs puts KSF at the leading edge of physician practices nationwide. In 2005, the National Center for Health Statistics at CDC reported that only 17.2% of physician offices used EMRs, compared to one-third of hospital emergency departments.

The KSF Experience

“We started the implementation process in August 2004,” says Berkowitz. By November 1, 2004, the Sports Medicine Center at KSF was up and running with EMRs, serving as a pilot. And by February 2, 2005, the entire clinic at KSF was brought on board. All new patient records from that day forward went directly into electronic storage.

“We really started years before the first phase of implementation,” says Berkowitz. Everything from selecting a computer platform for EMRs to scheduling the phases of transition must be done with deliberation, he explains.

Albert D. Cuellar, MD, an orthopaedic surgeon at KSF, is the “visionary” who got the entire effort rolling, says Berkowitz. “Dr. Cuellar really spearheaded a long and complicated process,” he explains.

In the early 1990s, Dr. Cuellar visited a clinic in Los Angeles where EMRs were already in use. He came away impressed by the potential EMRs held for contributing to the highest quality patient care. At Dr. Cuellar’s urging, a task force formed to evaluate the feasibility of transition to EMRs at KSF. The working group included physicians, physician assistants (PAs), and registered nurses, as well as staff from medical records, the business office, and the front desk.

The EMR system had to meet criteria of fidelity and reliability, says Berkowitz. Once data were stored electronically, there had to be the certainty that it could be retrieved without corruption or delay.

After considering several systems, KSF chose Logician®, a product of GE Medical
Information Technologies, as its EMR platform. The system allows physicians and clinical staff to document patient encounters and also to share clinical data securely with other providers and information systems.

It is now possible, for instance, for MRI (magnetic resonance imaging) results to be imported to a patient chart directly via electronic exchange. Eventually, paper faxes and couriers will be distant memories.

Approximately 140 users rely on the EMRs at the two KSF locations. They include 13 physicians, seven PAs, and seven occupational therapists and physical therapists, as well as the nursing and office staff. KSF designated Anisha Malik, RN, as Project Manager for Electronic Medical Records.

Showing Results

“From the nursing department perspective, we are extremely pleased with the ability to handle refills and use charts with no waits,” says Malik. If a patient calls in regarding a prescription, she explains, a medical professional can immediately obtain the records for the patient.

That is true even if another user on the EMR system is accessing the patient records.
Paper charts, in contrast, often required “chasing down” because they were in use elsewhere or had not yet been refiled.

The full implementation of EMRs takes considerable time, explains Malik. Paper records must be scanned and converted to EMRs. Some of that scanning is done in house, and some is done offsite. In addition, says Malik, there is the familiarity factor that must take hold. There is a new lexicon — a new lingo — that everyone must learn to describe new processes and also to fine-tune them, she says.

Consequently, not all choices regarding EMRs are made at the onset. “There is continuous decision making,” explains Malik. “You have to ensure you get information out to all department supervisors in advance of modifications or changes.”

Berkowitz agrees that the process will be ongoing. But the happiness of the nursing staff and business office personnel with expedited transactions related to pharmacy and billing has already translated into making physicians happier, he says.

Physicians can choose to add data to EMRs directly throughout the day as they see patients. They can enter data directly via a keyboard or by voice. Results of laboratory tests and imaging and surgery reports are already imported to the system by electronic transfer. The need for fewer transcription and clerical services means a reduction in operating costs at KSF.

Physicians can access data from computers at satellite locations. “We are working on access with PDAs [portable data assistants] or hand-held devices,” says Malik.

What Is Next?

“We wanted a seamless program to do a few things as quickly as possible,” says
Berkowitz. And he believes KSF has succeeded in meeting that objective. “There is a huge integration that needs to go on,” he explains. “What Dr. Cuellar is trying to do is develop new processes.”

When the full potential of EMRs is realized at KSF, patients will benefit in multiple ways. Continuity and coordination of care will be more transparent. EMRs also make it easier for physicians to send reminders and education materials to patients. They also ensure that patient follow-up is done on schedule.

Because EMRs can link to guidelines and documentation tools, they simplify the access physicians routinely seek to the changes in treatment protocols and documentation requirements of regulatory agencies and bodies.

There is a learning curve with any large-scale change in a practice, especially one of such magnitude. “This is a huge project,” says Berkowitz. “In the 15 years I have been here, nothing can match changing to electronic medical records in terms of commitment required.”

But being ahead of the curve in health care, doing whatever it takes to put patients first, is part of the philosophy of KSF. So making the commitment to invest wholeheartedly in EMRs was something all the physicians at KSF agreed on quickly.


Sidebar:
New Web Site Designed With Patients In Mind

As part of KSF Orthopaedic Center’s commitment to its patients, the group built a new Web site that went live in January 2006 to help integrate the wealth of information available to patients. The site has downloadable forms so patients can have them filled out and ready before they even get to the office, greatly decreasing the wait time at the office.

There is also a section to schedule appointments online. “The new Web site was designed with the patient in mind; it was built to incorporate all the various facets that make KSF a complete orthopaedic care facility and to help educate patients on common orthopaedic problems,” says Aaron Kant, Marketing Director for KSF.

The Web site will continue to grow, with more information added every month. Patients can visit the Web site at www.ksfortho.com. If patients have specific questions, they can e-mail KSF through the Web site as well.