Jacqueline Fincher, MD, FACP
Selecting and implementing an electronic medical record (EMR) system took nearly a decade for McDuffie Associates Inc., a four-physician practice in rural Thomson, Ga. So what took so long? Consistent with reasons often cited by physician practices, it was a combination of the large price tag and finding the right system that required avid due diligence. Three years ago, however, Jacqueline Fincher, MD, FACP, and her business partners decided it was time to make the move.
Dr. Fincher, a self-proclaimed "middle-wave" technology adopter, recently spoke with the AMA about her EMR experiences.
AMA: Why did you decide to implement an EMR system?
Dr. Fincher: We were looking to improve our documentation, charge capture and maintenance of problem lists and medication lists, as well as eliminate chart pulling and chasing. We also felt we could improve our workflow and deployment of staff, minimize prescription errors, enable remote access, participate in future pay for performance (P4P) programs and automate protocols for screenings and immunizations.
AMA: What were your expectations of the EMR system?
Dr. Fincher: We expected more than was available! Ten years ago, when we started looking, we didn't feel the systems were ready. About five years ago, we started looking intently and were more hopeful about the capability of the systems.
AMA: What did you do to prepare?
Dr. Fincher: After attending a conference that compared five top systems, we called those vendors. We narrowed our list to three, and then visited practices using the systems. One physician, one clinical staff person and one administrative staff person attended each site visit. It was essential for us to have every aspect and perspective of our practice represented. In fact, our practice administrator was the detail driver for our EMR implementation, and the physicians focused more on the strategy. Due to the small size of our practice, we felt it was safest to go with GE's Centricity EMR.
AMA: How did you work the EMR system into your current workflow?
Dr. Fincher: Before we implemented the EMR, we documented the workflow for every kind of visit and situations that can occur in our practice (such as tracking labs, taking a message, etc.) We then turned the written workflows over to the EMR representative to create the workflows in the EMR. Our EMR representative then worked with us over a five-month period to implement the new workflows. The representative was also onsite for three days after go-live.
AMA: Have you achieved a return on your investment?
Dr. Fincher: Our hope was to achieve return on investment in year four. We're in year three, and we aren’t going to make it. Our productivity is now where we were before the EMR. But it has taken a while to learn how to maximize the system.
AMA: What are the next Health IT steps for your practice?
Dr. Fincher: We are implementing electronic prescribing within the next two months. We are also planning on upgrading to the most recent product that GE has produced, which combines the two systems, PM and EMR, into one product. By having a product with both PM and EMR, a practice can save money on hardware and reduce any errors on interfacing.
AMA: What would you tell a colleague thinking about implementing an EMR system?
Dr. Fincher: Get going! Look at your practice management (PM) system, and find EMR systems that interface with it. You want your PM component in place several months before you take on the EMR. The PM component is not nearly as difficult to implement, and it generates the billing and your payment. The PM component can also “push” the diagnoses list to the EMR component, saving some effort/time once the EMR is in place.
Talk to the primary hospitals and labs in your area about their interfaces. You could save money because you may have a better bargaining position with the vendor.
Once you are ready to implement the system, get your team ready. Commit to a timeline. Ours was five months. Communicate with staff and patients. Communication is the key to success.
If possible, plan the implementation around a slow time of the year. Plan on reducing your schedule for the first few months. And, don't feel that you must scan every paper chart. Scan only a facesheet/worksheet of important details--problem list, meds, last labs, immunizations, preventive/screening tests done--and preload them into the system. It is a good idea to have everyone, including the doctors, preload charts. This allows everyone to navigate through the system without the pressure of a patient standing in front of them.
AMA: How has your staff reacted to the transition from paper records?
Dr. Fincher: Some of our staff came from practices that used EMRs, so they understood the benefits. Others were hesitant and even resistant. Interestingly, some of the resisters became our super users. We have realized the benefits of EMR, so if you ask any one of our employees, they will tell you they would never go back to paper. One physician still complains now and again about the system, but he knows it was the right decision. Besides the obvious benefits, there are others. We have participated in the Physician Quality Reporting Initiative since 2007, and we have applied for NCQA certification, which will allow us to participate in Bridges to Excellence.
AMA: How have your patients reacted to the EMR system?
Dr. Fincher: Our patients love the EMR now. It makes them feel like they are in even better hands. We can show them trends. For example, we have visible graphs to show them that their medication is working.
AMA: In what ways has the EMR system changed the way you practice medicine?
Dr. Fincher: I know I am a better doctor because I went to an EMR. For example, it's efficient for me to use protocols for health screenings; they are just one button away. I can also track referrals to make sure no paperwork, lab or radiation reports were lost.
Please send Dr. Fincher questions or comments at hit@ama-assn.org.
Visit www.mcduffiemedical.com for more information about McDuffie Medical Associates P.C.
(i)The American Medical Association (AMA) does not endorse the products or services referenced in this interview posting; (ii) the views presented are those of the individual physician and not the views of the AMA; and (iii) the physician has represented that the views presented are a balanced assessment by that physician of his/her personal experience and have not been prepared at the request of or for the benefit of any third party but solely to inform other interested, similarly situated physicians.
