Once you commit to an EHR, don't turn back, doctors say

Once you’ve committed to using an electronic health record (EHR) system, don’t turn back, no matter what obstacles you encounter. If you do, you risk complicating your situation.

That was among the lessons Medical Economics EHR Best Practices Study participant M. Louis van de Beek, MD, has learned in the process of implementing his McKesson EHR system.

A solo family doctor with an office in a residential neighborhood just outside Philadelphia, Pennsylvania’s center city business district, van de Beek first went live with his system’s billing component in September. To do so, however, he had to switch billing clearinghouses. The result was not what he had expected.

“It created a huge logjam in our Medicare payments as we tried to make the transition, failed, and went back to the old clearinghouse,” he recalls. “Medicare [payments] basically stopped dead for 6 weeks, and that’s about 20% of our income.”

The practice finally received a payment from Medicare in late October but still is encountering difficulties. “It’s all bollixed up,” van de Beek says. “Fortunately I have a few bucks in the bank, but if the situation gets too severe, it will become a major obstacle for us.”

Another lesson, he says, is that in-person instruction on using an EHR is far more effective than long-distance training. The first training McKesson provided for him and his five employees was conducted by telephone. But glitches, such as the system’s inability to move to the next step without first entering all nine digits of a patient’s ZIP code, were difficult to address over the phone.

After repeated requests from van de Beek, the vendor agreed to send a trainer to his practice for 1 day.

“The on-site visit was incredibly helpful,” he says. “Over the phone, it can be difficult to understand what you’re supposed to do. But with someone there showing you, it becomes the old medical school axiom, ‘See one, do one, teach one.’ The learning curve becomes a lot quicker. Many of the glitches we ran into just involved taking a different path to get where you need to be.”

The McKesson trainer also was able to tweak the program’s software so that it no longer requires a patient’s four-digit ZIP code extension.

Other costs associated with implementation (excluding the EHR system) tallied up to about $3,500, which covered three new laptop computers, a scanner, a router for a wireless network, and a consultant to set up the network.

Van de Beek estimates that it will take 4 to 6 months to get information for all of the practice’s approximately 900 regular patients into the system. Although his staff has been entering some patient data, he inputs information about patients’ medications himself.

“My handwriting isn’t that great, and my people don’t necessarily know all the meds,” he explains.

Van de Beek enters the information while seeing each patient, during his lunch break, and whenever else he can find free time, with the goal of entering information about five to seven patients into the system each day.

That leads to his third piece of advice for future EHR adopters: “Be sure you’re allotting enough time for this process, because it’s incredibly time-consuming,” he says. “Certainly, at least for the week you go live, you’d want to decrease your clinical schedule. Perhaps try to implement during a time of year when things are a little less busy.”

Despite the frustrations he has encountered with his system, van de Beek thinks EHRs are worthwhile.

“I can absolutely see the benefit of medical information being available electronically,” he says. “It’s important to be able to access information should a patient end up in the emergency department or the hospital. I know how important it is to me when I first see a patient that I have clear information about their prescriptions, their diagnoses, and their treatments, and it’s more efficient to be able to check someone’s labs or tests instead of ordering new ones. Having access to that information will enhance the quality of care.”

-Jeffrey Bendix, Senior Editor

Stack of papers has disappeared from desk, participant says

If you choose a Web-based electronic health record (EHR) system, be prepared for it to be inaccessible when Internet access is down or when it goes offline for repairs or updates.

That’s the advice Felix Sokolsky, MD, shares, adding that otherwise, he has an overall “good relationship” with his system and particularly enjoys that the system enables him to participate in Web seminars.

Before implementing a MedNet Medical Solutions system a few months ago, the Maryland doctor says that his practice relied strictly on paper records. So now, the stacks of papers that used to be piled up on his front desk have disappeared.

Sokolsky says the new system itself didn’t cost him money to implement, but he did have to make a large investment in computers and equipment. Also, the practice’s staff needed quite a bit of training, but they are improving in their use of the system every day.

He says he isn’t using the system to interface with patients yet, but he plans to make lab results and individual records available to them at some point in the future.

-Rachael Zimlich, Associate Editor

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