As many of you know my office has been using my beta version of electronic medical records for nearly 12 years now. We see a high volume of patients, maximize efficiency, and are able to be very successful financially. You may also know that I have spent the better part of 6 years working to bring my office system to you (details below). We have had lots of “redos” and false starts along the way, but we are now at a position I’ve hoped to get to for a long time…..introducing you to Serenity. I’m very excited about this next step in the 15-year process of developing the most effective EMR system I can imagine.
I’ve attached a video showing a general overview of our system. Or you can also watch it here. For best results, be sure to click the button to watch it in HD mode and full-screen. I’m previewing this to all of our subscribers in anticipation of our official launch next month.
I would like to share with you my take on Electronic Medical Records (EMRs). I’ll refer to this as the history according to Paul, since this is what I’ve noticed. My first experience with EMRs started almost exactly 17 years ago. I was doing a rotation in medical school with a family medicine physician who just spent about $50,000 on a medical record system.
He was very impressed with the program and showed me how it could manage the chart and track of all the notes and labs. It could scan in notes, reports, and letters and have a way to store the patient’s demographic data. I was a little bit of a computer geek in my spare time and looked at it through those eyes and figured out that all this program really did was replace the paper chart.
Every doctor and every clinic had rows and rows of shelves of paper charts. In addition, they also had boxes and boxes of stored old charts. Paper was everywhere. And of course, the chart we wanted wasn’t filed appropriately. Is it on the doctor’s desk? Nope; look in the lounge. Not there either. How about in one of those stacks in the receptionist’s area? No? Well look in that pile on the floor beside the doctor’s desk. Not there either? Well maybe I took it home; I’ll look tonight.
Sound familiar? Not so much nowadays, but back then that was a very familiar game to play ‘where’s-the-chart.’ If only we could have some way to keep track of everything on a computer and not have to find the actual, physical paper chart. And that’s what happened. The early charts served a basic and simple purpose. They allowed the office to go paperless. And that’s about all they did.
I made a few decisions at that point:
So I went to the library and checked out a few books on programming and started writing an EMR program on a yellow legal pad. Two years later my parents bought me my first computer when I graduated from medical school. Boy did that make it easier to program.
Unfortunately, there are many EMR programs still on the market like this. But some kept progressing.
Then about 14 years ago I was half-way through residency and Medicare came out with their 1997 guidelines. Bullets everywhere as far as the eye could see. EMR programs made a dramatic shift at that time. Before all they really did was keep track of the paper chart and schedule on a hard drive. Now the shift was being made to turn the EMR into a tool to help the doctor with compliance.
The new guidelines said that we needed a certain number of bullets for History, this many bullets for review of systems, that many bullets for physical exam, etc. Now we had this tool that could make sure all the appropriate bullets were checked. Even better, we had the wonderful concept of cut, copy, and paste. All of a sudden our hand-written notes that were maybe 2 inches long on paper could turn into 3 page notes just full of bullets and copied material.
Of course many of you have come across these 3 page notes. Most of the note is negative filler. Or what I like to call ‘CRAP’. Unfortunately, there are still many EMR systems on the market like this, but some kept progressing.
Next EMR systems started tackling the billing concepts. At first, they simply stored all the patient information, demographics, practice information, and codes. The billing person could then regurgitate all this information onto a printed HCFA form. We all still mailed them in at that point of course. The internet was new and not to be trusted.
More advanced systems then began to keep track of separate cases and charges and track them over time. This started in the hospital where tracking charges and payments was an incredibly inefficient task and then progressed into the outpatient setting. It wasn’t always a good fit, but over a few years most of the billing systems became reasonably proficient at doing the simple accounting tasks.
Eventually this turned into electronic claims and now thankfully it is the rare time when anyone has to print out a ‘1500’ form. This is about the state we were in when I finished residency.
Unfortunately there are still many EMR systems on the market like this, but some kept progressing.
When I started my practice out of residency, EMR systems either cost $50,000 and up, or they were only a few thousand dollars and had very few features. Both systems at that time (1998) left much to be desired.
I had some knowledge of computers, some knowledge of writing notes and documentation, $80,000 of medical school debt, and less than $1000 in my bank account. I had 2 choices: paper charts or make my own system. So I did in my mind what was the logical choice: Both.
I made a system that would hold and help me write my progress notes. Then I would print them and stick them in the paper chart. Later I wrote a module to help me write prescriptions. Next was a module to help me write and track the past medical, family, and social history. Allergies were next (I know, they should have been first). Later I wrote a module to import and store data that was scanned in like labs, radiology, and correspondence.
Then in 2002 I made the leap. I went paperless. It was very exciting. And very scary. But as I looked around at the EMR systems on the market, I realized that I had just progressed to the first level of EMRs.
Another interesting thing happened about that time. I fulfilled my hospital contract and was out on my own financially. And realized that I was losing money through inefficiencies throughout our office. Some things were not being billed. Some things were not being charted. Even worse, many things needed to be done and were not even being ordered! So now what?
EMR systems now shifted to the realm of practice management. No longer were they content to just store data. Now it was important to track information and use this in order to improve efficiency and income of the clinic. The next module I wrote in my system was the ‘Procedures Due’ module. I know, that’s not the best name, but it worked. This took a list of all our procedures from spirometry to pulse oximetry to strep tests and hearing exams and allowed us to determine a ‘schedule’ of who needed these tests and how often.
Now when the nurse checked in a patient, the computer would immediately spit out a list of all the procedures that were scheduled for a particular patient. It wasn’t a perfect system, but it worked. It worked very well.
I pulled the numbers. I pulled reports on how many patients we were seeing every month before and after this module was implemented. I also pulled reports of how many procedures we were billing for and how much extra income was the result. The numbers surprised even me.
In my one-physician clinic, without seeing any more patients, my income immediately went up by $4,000 per month by implementing this. I currently have 4 providers in my clinic and can still attribute $15K per month directly to this feature. I realized that maybe it was time to spend $50,000 on an EMR system. If I did this much better with my ‘home-made’ system, just think what I could do with one made by a big company.
So I started downloading demos and (yikes) talking with salesmen for the big fancy EMRs in the $50K to $75K range. I looked over them all and came to a conclusion. They were all basically CRAP. Very expensive, bright and shiny, with good marketing and pretty websites and slick mailers. None of them helped with the practice management as well as my system.
So I made the next big leap. I hired a company to take my model and turn it into a retail EMR system. For better or worse, that was 6 years ago. Now many EMR systems have come into the Practice Management Phase, but not all. About 4 years ago I moved into the next phase with my EMR.
This I believe is what sets apart my EMR from everyone else in the market. I’ve been doing conferences for the last 7 years trying to help physicians improve their practices. I apply the same logic to my own practice. My goal at the beginning of every day is to finish every day giving the best patient care I can while spending the LEAST amount of time possible on all the non-patient care “stuff”……the charting and documentation.
I’m going to talk at length with you all next week about workflow. Let me sum it up for you in a couple of sentences. Why do we use word processors instead of typewriters? Why do we use ATM cards instead of checks? Online banking instead of going to a teller? Shopping at Amazon instead of a real store?
Because it saves us time and makes our lives easier. The reason I spent all my money and time developing an EMR system is the same reason I haven’t bought one that is already done. It would have been much cheaper and easier for me to spend $100,000 on a system and not worry about mine. But I haven’t found a single one that has made my life easier.
Seems like a simple litmus test to me. On average I spend about 30-60 seconds per patient doing documentation with my EMR system. On average, it takes us 10 minutes to train a new employee on our EMR system. On average, this system makes us an additional $150 per provider per day in profit from capturing patient care opportunities.
Finally a computer system in the medical field that improves my quality of life.