Article Date: 8/1/2011

Need a Reason to Invest in EHR?

Need a Reason to Invest in EHR?

Experts give you six … and none of them have to do with government incentives.

Lee Ann Murphy, Contributing Editor

Yes, electronic health records (EHR) systems are an expensive investment. But do their returns amount to an offer you can't refuse?

“When you combine the government money we're getting right now with the cost savings you gain simply by no longer having to pay someone to file paper charts, that cost argument starts to go out the window,” says Richard Driscoll, O.D., of Total Eye Care, with locations in Colleyville and Keller, Texas.

And the savings from filing are just the beginning. Here are the top six ways EHR will pay for itself in cost savings and increased quality, according to your colleagues, (and they don't even mention government incentives.)

1 Payroll savings

EHR can dramatically reduce your staffing needs. In fact, Kim Castleberry, O.D., president & CEO of Plano Eye Associates in Plano, Texas, says EHR enabled him to reduce his staffing costs by half from 24 full-time employees to 12. Electronic claims submission as well as electronic check deposits and remittance accounted for a big part of the decrease, he says.

“Eliminating double entry of information into insurance company portal sites allowed us to eliminate one fulltime staff position who was responsible for nothing but claims data entry,” Dr. Castleberry explains. “And streamlining our medical records management by getting rid of paper charts allowed us to eliminate another position responsible for nothing but managing paper charts.”

Dr. Castleberry says his system automatically populates a fee slip with CPT and ICD codes, and the practice has trained its doctors to link the CPT/ICD codes and assign insurance companies when finalizing the exam. This saves time in the front and back office by reducing demands at check out in addition to claims resubmission due to errors, he says. This savings allowed the practice to eliminate one full-time administrative staff member as well, Dr. Castleberry says.

The practice arrived at additional savings through:

► electronic prescriptions, which curbed pharmacy calls and call backs
► online optical use, which reduced the staff needed to manage contact lens orders
► optical prescription verification, which cut back on staff calls and call backs to the lab.
► electronic appointment confirmations, which eliminated staff phone calls to patients
► electronic notification for spectacle and contact lens orders, which automated these tasks previously done by staff
► EHR “Auto-Letters” to providers, insurance companies and patients, which eliminated the need for dictation and transcription services.

But EHR isn't necessarily about reducing staff, agreed those interviewed. It's also about freeing up existing staff to do more meaningful, practice-building work instead of filing and looking for charts or resubmitting paperwork multiple times. Karen Perry, O.D. F.A.A.O., of Perry Eye Care Associates, in Orlando, Fla., says she's kept her staff steady since implementing EHR three-and-a-half years ago, and now they are spending more time on patient care.

“We are able to place more focus on direct patient interaction rather than the back-end operations of the business,” Dr. Perry says. “Where a staff member might have been pulling files before, now they are making courtesy calls, writing thank you notes or making calls to patients who have been diagnosed with glaucoma to see whether they understand the diagnosis, or whether they have any questions for the doctor. These are value-added benefits that we can more easily offer to patients now.”

2 Improved quality control

“The biggest reason to do this [use EHR] is for better records,” says Dr. Driscoll. “I get paper records from other doctors, and I can't read them. Or, I can't find the information I need. Here, everything is legible; everything is in there.”

Dr. Driscoll says he can build logic defaults into the system “that flag the file if, for example, IOP is over 23mmHg or if you forgot to put in a piece of information.”

Dr. Castleberry says he enjoys similar benefits. In his system, a feature allows for precise exam annotations. Integrated image management puts images at the point of care, and electronic prescriptions check drug-to-drug, drug-to-disease and drug-to-allergy interactions. The system benefits go beyond legible and easily accessible exam notes, he says. “EHR encourages and supports precise documentation and thinking throughout the case that improves the quality of care and reduces legal exposure” Dr. Castleberry says.

3 Real estate savings

Paper files need space, and as a practice grows, these files require more space. Dr. Castleberry says he saw the rewards of EHR when his practice relocated: He says he was able to reduce square footage by 500 square feet — space that was used in the old practice for housing its 45,000 paper records.

4 Enhanced disaster prevention

This year's torrent of tornadoes, floods and fires proves that no location is safe from natural disaster. When paper files are destroyed, they are gone for good. An electronic system that is regularly backed up off site could save an entire practice in the event of catastrophe, says Dr. Castleberry.

“You absolutely must develop an off-site and local data backup strategy,” he says.

5 Easy referral and consult letters

In the past, a referral letter required setting time aside to write or dictate the letter, then tasking a staff person with typing and formatting it, sending it to the patient or doctor, confirming it was received and resending it if it wasn't. Times have changed, says Dr. Driscoll.

“Now, [with EHR] we just merge the fields that are applicable, do it right there in front of the patient and give it to them when they leave. It's a huge time saver,” he says.

6 Effective marketing

Dr. Driscoll says he's found that electronic records have dramatically improved the performance of his marketing dollar in two ways. First, he can now sort files based on patients' specific medical needs and send out targeted mail to them.

Second, by using patient demographic information along with medical information, Dr. Driscoll say his EHR can create reports that tell him which marketing methods yielded the most revenue.

“We ask new patients how they heard about us and record that into the system,” he says. “The medical records show us how much revenue was earned through that visit. Now, I can run a report at the end of a certain time period and see how much revenue we got from certain marketing techniques.”

For example, Dr. Driscoll compared how many people learned about his practice through the practice's signs, vs. the practice's Yellow Pages advertising.

“We found our Yellow Pages ad was very unproductive, so we cut it back and went more toward Internet marketing,” he says. “In reality, that piece of intelligence alone might have paid for the whole system.”

7 Making the leap

Of course, choosing a system and implementing it — even if it pays for itself in a few short years — is a daunting task. Therefore, to make the process successful, it's important to do your research up front, says Dr. Driscoll. Specifically, he recommends you talk to your colleagues and examine their systems “in play.” Dr. Castleberry suggests going with an established software provider that you are fairly confident will be around for the long haul.

Next, ask about tech support.

“Look at the company's ability to support you,” says Dr. Perry, “because it does take a lot of time and effort. You need a partner.”

Dr. Perry's vendor offered a single point person who assisted the practice throughout the implementation.

Once the system was up and running, a trainer came on site who was educated in the eye — not just a technician who “knew how to work a computer,” says Dr. Perry.

Lastly, take a step-by-step approach to make the changeover as seamless as possible.

Start with the easy and more straightforward modules, like patient demographics, insurance information and scheduling. Next, incorporate electronic contact lens orders and spectacle prescription orders. Then, says Dr. Driscoll, tackle medical records.

No doubt going electronic is a seismic shift for any practice. But the benefits make it worth it, say those interviewed. OM

Ms. Murphy is a freelance writer and editor based in Fairfield County, Conn.

Optometric Management, Issue: August 2011