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Physician Spotlight: Paul Buehrens, MD

A successful transition to electronic health records does not always mean you hit the implementation targets in time. Although Lakeshore Clinic in Kirkland, Wash., deems its transition to an EHR system a success, it took a little more planning and time. The end result, however, was worthwhile for the 17-physician practice. The practice considers its gained efficiencies and quality measurement activities key to improving patient care and to keeping its doors open.

The American Medical Association’s Health Information Technology group recently spoke with Lakeshore Clinic Medical Director Paul Buehrens about the clinic’s EHR system implementation.

AMA: When did you first implement an EHR system and what prompted your decision?

Dr. Buehrens: What’s the saying? “Necessity is the mother of all invention?” We were simply drowning in paper. In 2004, our practice was part of a consortium of eight medical groups that decided to make the transition to an EHR system. Only five groups made it to the implementation stage, however. Two groups went bankrupt; another wasn’t interested in merging pension plans.

We went live in September 2005—about two years after we began our vendor search. We first went live with the practice management system (PMS) in February 2005. We were glitch-free in a month. We implemented the EHR with 99 percent accuracy, which equated to only about 400 errors out of 100,000 records. This is entirely attributable to the training of the staff beforehand.

AMA: What did you do to prepare? (i.e., readiness assessments, cost and ROI analysis, etc.)

Dr. Buehrens: Our original analysis determined that we would see a return in 18 months; it didn’t happen for almost three years. That’s not to say it wasn’t worthwhile. More importantly, though, we made site visits to look at various EHR implementations in the region. We didn’t find one that we wanted to replicate; we wanted better.

AMA: How did you select your vendor?

Dr. Buehrens: While we were all like many physicians—business owners and line workers with no time—we made the EHR/PMS selection a priority. We established a task force to look at the field of EHR/PMS vendors and to make a short list. We sent a request for proposal (RFP) to 14 vendors. Four vendors demonstrated their systems on-site, and two bid for the work.

AMA: What were your major obstacles during implementation?

Dr. Buehrens: We thought the vendor would provide more support. So we quickly turned our focus to a “train-the-trainer” model. We hired an IT staff person, but we also morphed our staff heading up quality into an implementation team. This team then trained the entire practice. All the physicians were trained in 15 months.

We were the only practice in the consortium that took this path, and we ended up extending training services to the other four groups until we couldn’t sustain those efforts. We eventually left the consortium.

AMA: How did your practice prepare for the implementation?

Dr. Buehrens: The implementation was done in the background by trained staff. During the six months prior to the EHR “go live,” each physician filled out one sheet—complete with problem lists, medication history, allergies, vaccinations and immunizations—after each patient visit. Then the administrative staff entered this information into the EHR system. We didn’t scan entire charts.

Every physician still managed to see 24-26 patients daily. We never experienced a loss in productivity. In fact, we cut overhead 10 percent and increased productivity by nine percent. Paper chart pulls disappeared after a month.

AMA: How are you currently using your EHR?

Dr. Buehrens: Our prescription refill process and our quality improvement efforts are the most illustrative. The efficiencies gained through the EHR allowed us to train one of our chart-pull clerks on data entry into the electronic prescribing system. Refilling a prescription takes about five seconds now, a few stylus clicks. We also have a full-time LPN dedicated to data mining, so we are able to improve our quality and benchmark against all other practices running the GE Centricity EHR.

AMA: What have been your practice’s greatest clinical and operational achievements?

Dr. Buehrens: Survival, and the foresight of our staff to pursue data mining for quality improvement.

Quite simply, our EHR system saved the practice, and, most of all, we now provide better patient care. It wouldn’t serve our patients to go to work in hospitals, and that’s where we were heading. 

AMA: What is your perspective on non-physicians defining quality?

Dr. Buehrens: Look, we [physicians] already know what good quality is, it’s just patients aren’t coming in. Take our diabetic population, for example. We sent letters to 1,000 diabetic patients; 700 came for a visit. You have to see patients to provide better care. We couldn’t have done this with paper records.

AMA: Why has your practice succeeded?

Dr. Buehrens: We had the best implementation. We also do things like allow our newer users to shadow the more experienced and efficient ones to see how they might improve.

AMA: How do your patients react to the technology?

Dr. Buehrens: We hear a lot of “wows.”

AMA: What would you do differently?

Dr. Buehrens: We purchased voice recognition with the EHR system, and our hardware didn’t have enough bandwidth to support it. And, at this time, primary care is still more complex than most voice recognition systems. We will probably implement the technology in the future, but it’s very expensive.

AMA: What are your future plans for HIT?

Dr. Buehrens: We can’t fully take advantage of real-time systems until we can get rid of the paper “super bill.” We also need to order labs and tests electronically, in addition to adding a secure patient portal. Now that we know how to use our data, we’re looking into a few pay for performance programs. Eventually we’ll report our cardiology data electronically. We plan to apply for more National Committee for Quality Assurance certifications as well.

Please send Dr. Buehrens questions or comments at hit@ama-assn.org.

Visit www.lakeshoreclinic.com for more information about Lakeshore Clinic.

(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.

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