Internal Medicine Center, LLC (IMC), a multi-specialty practice with 20 providers, is the largest independent clinic in Mobile, AL. Established in 1946, it’s also the oldest, compiling over 60 years of patient records.
With so many specialties—and specialists—IMC’s Board of Directors wanted to use electronic medical records (EMR) software to improve operational processes, encouraged by the promise of ARRA stimulus money to help fund it. But IMC’s Practice Administrator, Christine L. Holliman, CMPE, took a more pragmatic view of the situation.
“All vendors talk about the efficiencies of an EMR and the increase in the levels of coding that can be achieved from full implementation,” she says. “As my physicians are many different ages, the idea of transitioning to a full-blown EMR was daunting, to say the least.”
And expensive, especially in light of what Holliman perceived as a fundamental lack of functionality. “The document management portions of the leading EMR systems we looked at, including Greenway, Centricity and Allscripts, didn’t utilize OCR [optical character recognition] technology or any other shortcuts for actually scanning and filing documents,” Hillman notes. “Most EMR systems require manually sorting and dragging and dropping individual documents either back to an order or back to a patient record—very cost prohibitive in my opinion.”
Holliman focused on finding an enterprise content management system (ECM) to establish electronic patient charts (e-charts) first. “Looking for a way to handle the paper felt like the most logical step in streamlining our practice in preparation for an EMR,” she says.
“As most of our physicians are still primary care, the sheer amount of paperwork we receive is just incredible,” Holliman adds. “We’d receive 2 ½ feet of paper a day in faxes, print-outs and mail—and that’s just from one of the two hospitals we work with.” At the same time, she notes, “as a multi-specialty practice with 20 providers, having a system that could allow access to patient records by multiple departments and personnel was critical.”
The 2 ½ Feet of Paper Stops Here
Holliman was introduced to ECM, Laserfiche by Jim Bergeron of reseller JPI Data Resource at the 2009 MGMA conference in Denver. She then met Bergeron again at a local HIMSS meeting. Encouraged by Laseriche’s enterprise content management ease of use and its flexible business process management (BPM) automation tools, IMC purchased a 44-user Laserfiche Avante system with Workflow business process management and Quick Fields capture tools to establish electronic patient charts.
“As anyone who has implemented new systems knows, the end users are the biggest variable. If they’re on board, the implementation will be a success,” Holliman says. “With 140 employees with varying computer experience, it was very nice to implement a product that anyone could be taught to use in just a few minutes.”
Key to establishing IMC’s e-charting was automating the way the clinic received patient information from the two hospitals it works with. Using enterprise content management in conjunction with the MD Network, an electronic patient information distribution platform, incoming documentation from hospital visits is processed by Quick Fields’ high-volume capture and processing tools, then automatically filed in Laserfiche according to patient name and date of birth, where it becomes part of patients’ e-charts.
A significant amount of this data is test results, which need to be reviewed by physicians; this review often prompts follow-up instructions and further review. “One of the worries of both physicians and practice managers is if test results have been reviewed and relayed back to the physicians,” says Holliman.
Flexible Control: Reviewing Test Results as a Condition of Filing Them
To automate the test review process, IMC created separate “inbox” folders in the Laserfiche repository for each physician. Quick Fields recognizes “test results” as a document type and the physician’s name associated with it, which Workflow then uses to route the results to the appropriate doctor and nurse’s folder. Workflow then alerts them they have items in Laserfiche for review. If a review deadline is not met, Holliman herself is notified.
“One of the things we really liked about ECM was that all of our doctors can set their own parameters as far as what they need to see in their inboxes to review,” she says. A GI specialist who ordered a patient test, for instance, wouldn’t need to see an incoming discharge summary, but the patient’s primary care doctor would. The GI specialist would, however, need to review the results of a test he ordered, so only after he has reviewed it do the test and follow-up notes go to the primary care doctor’s inbox for review, and eventually to the patient’s file.
“Just using their inbox, each doctor can ask his or her nurse to follow up on their instructions. Whether it’s an abnormal lab or an abnormal chest X-ray, they can adjust medications or order further testing,” Holliman adds. The whole process is prompted, routed and tracked using Workflow.
The benefit, besides the economy of effort, is peace of mind, she says. “Our doctors can access the same, single inbox and know when they leave at the end of the day that they’ve seen every test result that needed to be dealt with on that day.”
Nurses who used to have to keep a manual log of all tests reviewed and what follow-up was ordered appreciate it as well, because logs can be generated automatically using simple search parameters. Plus, Holliman adds, “Being able to precisely track patient follow-up is a tremendous tool for mitigating medical legal liability costs, as we have an exact record of the doctor’s orders.”
A Natural Bridge to EMR—That Also Leads to Back Office Efficiency
Now that Laserfiche has made its impact on how doctors receive and act on incoming patient information, the clinic is rolling out Laserfiche for use in its business office, where Workflow will automate A/P processing and HR files updates.
“One thing that’s nice about Laserfiche is that it gives us a set of tools that can be applied to business management as well as practice management, so we’re really able to maximize our investment,” Holliman says.
At the same time, she adds, IMC is an important step closer to EMR adoption. “Laserfiche has definitely acted as an important bridge between where we were and where we want to be, and it’s done so in a way that’s been very natural.”
