The Best EMR Solution: In-house.

A little over a year ago my wife and I started our first business together. For me, this would be somewhere along the lines of my 7th venture, but indeed my first in the arena of health care. Although the semantics of it all were a bit different... the general ideas are similar. Aspects of efficiency, work flow, data management, bookkeeping, customer satisfaction and of course the bottom line where all present. "Business is business," I always told my wife to give her peace of mind.

We were both excited. My wife was then a newly graduated Optometrist eager to provide her prospective patients with the best eye exams they'd ever had. I, an entrepreneur with a strong background in computer technology, was very eager to see how this business model and corresponding challenges would compare to my past technology related businesses.

Opposing Viewpoints:
In short, managing two optometry offices proves logistically different than running say... a pay-per-click search engine or a retail store selling computers. It is a completely different animal altogether. One could expect to see many challenges. The greatest challenge was that of the opposing viewpoints. My wife embraced the viewpoint of the clinician, whereas I took that of management and stakeholder. This was due to our backgrounds and specific roles in the operation. We both agreed that profitability was important, that achieving profitability directly affect us both. However our different positions produced different perspectives that lead to many clashing views. The remainder of this blog will outline the challenges specific to embracing and implementing electronic medical records. Of course, there were many other challenges but I won’t go into those.

Why go Electronic:
Simple… electronic technology is cool. It really is. But that isn’t enough to convince any provider to embrace it. Nor is it sufficient to convince any stakeholder or management to throw money at it. I’ll start with the bottom line… ultimately technology utilized by any business needs to assist in the sustainability and profitability of that business. In heath care, these factors are intertwined with patient safety and satisfaction. Failure to achieve either of the latter can result in expensive liabilities. The goal then was to utilize technology to the extent that it maximizes patient safety and satisfaction without compromising profitability.

We further agreed that implementing technology for technology’s sake would prove to be an empty achievement. Trading pen and paper for screen and keyboard does not automatically produce improvements of any kind. Real improvements are realized when something can be deemed quantifiably better, i.e. faster, easier, higher quality, lower cost, improved patient satisfaction. There are areas where electronic solutions are pointless. More often, there are areas that are beneficial at one level of the operation yet an impediment at another. Each organization must clearly define the circumstances and assess organizational needs to determine the appropriateness of transitioning to electronic systems. In our case, we operate an optometry practice with a single provider in partnership with a large retail chain. Therefore, our needs will vary from that of say, an independent practice with multiple providers.

1. Eliminate Paper:

We wished to eliminate our dependency on paper along with all associated wastes of time and supply costs. The idea of being able to immediately pull patient information without searching an alphabetized filing cabinet seemed very attractive. In practice, it saves us only a few seconds at best. Keep in mind that we are a new practice with ~ 1600 patients thus far. An established practice with 10,000+ patients should realize tremendous time savings in this area.

Having this data in electronic format allows for a plethora of additional functions. If it’s quantifiable, a few lines of code can produce valuable information that can help guide the practice’s operations and decisions. Although pulling one patient’s file has been improved by a few seconds, processes which involve all patient files that might otherwise take days occur in milliseconds. That is but one substantial benefit to utilizing electronic systems.

But it’s not without its burdens. Keep in mind that data must first be entered into the system. Presently, we do not allow patients to access our office computers (I’m working on that.) Therefore, all initial patient paperwork is still… well, captured on paper and later entered into the system. This creates two main problems. The first has to do with legibility. Whereas patients have been complaining about doctor’s handwriting for years, now we are experiencing the reverse when attempting to read patient profiles. It is often difficult to make out the various handwritings and short-hand used by patients. The second is an indirect result of the first. This added step of data entry introduces another opportunity for user error. Data entry requires and interpretation of the patient’s handwriting and thus, can be affect by numerous factors. To alleviate this problem, we plan on having the patients fill out their information on a workstation connected to our system via a secure website. The workstation will be positioned to allow for patient privacy. We shall continue to offer paper forms for patients who prefer this method.

To be continued...