The Medical & Surgical Clinic of Irving, Texas, the largest multispecialty practice in the Dallas/Fort Worth areaincluding primary care/family physicians, general internists, pediatricians, gastroenterologists, ophthalmologists, surgeons and radiologistsrecently implemented a complete electronic health record to help its physicians improve patient care and significantly enhance the clinics financial position.
Medical & Surgical Clinic of Irving
In 2006, the clinic adopted a document-management system from a major EHR vendor and provider of automated physician-led health improvement and follow-up care solutions. The clinics goal was to improve care by automating the follow-up process for its patient population and thereby enhance the doctor-patient relationship and generate better patient compliance and improved patient health.
As a result, the automated follow-up process solution helped the overall coordination of care, specifically among patients with chronic conditions and those in need of preventive-care services. The new systems scheduling reminders hold up to pre-existing standards among the medical community and can be tailored to meet any and all of the clinics needs.
Costing roughly a few hundred dollars per physician per month, the clinics solution was implemented in 60 days. The implementation process took about 35 hours to implement with data extraction, including patient demographics, billing information and patient status, encompassing the first part of implementation. The data were transported via secure HTTPS, collecting the clinics deliverables, a data question and answer, and configuration. A 4-hour onsite workshop followed, as well as an additional 4-hour onsite training/go live support session.
The clinics medical records staff created an electronic record of all patient charts within the system, digitizing all incoming reports and correspondence, as well as the encounter forms that physicians use for documentation. This enables the clinics physicians to securely connect to and retrieve patient information quickly anytime, from anywherewhile eliminating the need to pull, file and store paper charts.
This technological solution has required minimal change in physician workflow. The systems document management program interfaces with the clinics internal lab system, so lab results are electronically filed within the patient record. The solution also allows physicians to create forms and use them in internal messaging.
The systems e-prescriber allows physicians to create medication lists, view formularies and drug interactions, and send prescriptions online to area pharmacies.
Significantly, the new system allows better management of the clinics population health, allowing a systematic approach to monitoring patients who are noncompliant and track the loss of practice revenue in terms of missed appointments. Because it automatically sends appointment reminders, this registry-based messaging greatly reduces the number of missed appointments and, in the past three years, has increased visit volume by several hundred thousand dollars.
This messaging feature also includes an electronic disease registry, evidence-based guidelines, and a customizable protocol engine to remind patients when to come in for recommended care. The registry manages a directory of all the patients with a particular condition, their treatment, and compliance rates and stores lab data to help the healthcare team monitor the patients condition against various health measures.
The clinical intelligence behind the solution consists of evidence-based health management protocols derived from such organizations as the National Quality Forum, the U.S. Preventive Services Task Force, and the National Committee on Quality Assurance. Using the flexible protocol engine, clinic physician leadership can easily customize the protocols individually for various preventive and chronic-care services.
In the first year of using the system, the number of appointments for physicians increased from six to 11%, depending on the physician. Overall revenue grew by $1 millionand growing. Specifically, the number of patient visits to family physicians jumped from 48,400 in 2005 to 52,400 in 2006. For pediatricians, the number of encounters increased from 41,000 in 2005 to 46,000 in 2006. In 2008even in the midst of recessionthe number increased to 49,500.
The clinics financial results relate directly to increased patient compliance. Patients who would have previously come in for follow-up visits on a hit-or-miss basisor not at allnow return on a regular basis.
The clinic is well-positioned to qualify for pay-for-performance rewards when private payers and Medicare begin offering P4P programs in the Texas area. It is already submitting data to the CMS Physicians Quality Reporting Initiative. The clinics outreach solution could also help it qualify as a patient-centered medical home.
The American Recovery and Reinvestment Act of 2009 will be highly favorable to the clinics population health management initiative because it requires meaningful use of EHRs to qualify for financial incentives. Clearly, this would extend to the ability to capture and report quality data. Today, few EHRsincluding those with the latest certification from the Certification Commission for Healthcare Information Technologyhave the kind of robust registry functions that the clinic now uses. In fact, many healthcare facilities use EHRs that do not include automated outreach capabilities, and even if they were combined with a commercial callout system, they would still lack the ability to tailor the messaging to clinical protocols. They cannot match the clinics ability to reach out to noncompliant patients at a time when noncompliance lies at the root of todays healthcare crisis.
Jeffry Michael Duke
Medical & Surgical Clinic of Irving
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