| CPR for the 21st Century |
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However, this could all be changing. According to a recent survey by the market research and management consulting firm Carmody & Bloom, nearly three-fourths of group practices with more than 20 physicians plan to implement electronic medical record systems within the next two years. To satisfy the demand for clinical information systems, software vendors are racing to develop electronic solutions that will help physicians meet the demands of an evolving health care system. According to Vinson J. Hudson, president of Jewson Enterprises, a leading health care market research firm in Menlo Park, Calif., there are close to 200 viable systems on the market today, ranging from those that simply record free text to those that capture structured clinical data and facilitate true outcomes research. John Campbell, a vice president with HealthPoint ACS, says comprehensive CPRs can help providers document clinical encounters, improve office workflow and analyze their practice. "The traditional method of keeping records in manila folders has many limitations and, more importantly, does not allow for analysis," he contends. Physicians taking the plunge Bay Shores Medical Group in Torrance, Calif., is a case study of physicians making a successful transition to computer-based patient records. Consisting of 100 full-time physicians with one main clinic and eight satellite offices, Bay Shores implemented a clinical information system from IDX, and was able to reduce clerical staffing by 60 percent and eliminate paper chart pulls in two satellite offices. The annual cost savings? More than $200,000. The group also gained immediate access to clinical and financial information that can help them make more prudent business decisions - a critical ability given that capitation makes up 95 percent of their revenue. Legibility and other benefits The desire to maintain legible records is certainly one of the most common reasons that physicians decide to implement computerized records. Many physicians feel the professionalism of their medical records should match the professional nature of the medical care they deliver, and handwritten notes can often be illegible when needed for a follow-up visit or in a malpractice defense. A CPR enables the physician to capture clinical information at the point of care and maintain access when and where it is needed again. In many cases, a CPR can also free physicians from routine clerical activities and allow them to concentrate on delivering medical care. "The CPR allows me to spend less time capturing routine data and focus my mental energy on what I was trained for, the assessment and plan," says Kim Meyers, M.D., an internist in Evanston, Ill., who uses HealthPoint ACS. "I also improve the face-to-face time with the patient because the information I need is already there. Improving communication with their colleagues is another reason many physicians have implemented a computerized patient record system. John Frederick, M.D., a family practice physician with North Memorial Health Care in Minneapolis, Minn., uses the Logician product from MedicaLogic to share clinical information with seven other satellite clinics within the NMHC system. "The greatest benefit of using a CPR is the ability to bring multiple clinics together into a truly integrated health care delivery system," Frederick remarks. Capital investment In many cases, the hardware required for a CPR system is often 80 percent of the total implementation cost and can range from a few thousand dollars when current hardware can be used to $20,000-$30,000 for a medium size practice with outdated computer systems. The critical cost issue is how much of your existing system can be utilized. Additionally, the software for a CPR system can average about $2,000 for a single user version with a sliding fee for multiple users on a networked version. Prices can range from under $1,000 for a simple charting system to $5,000 and up for a complex system with the ability to analyze and report outcomes information. The payback period on a CPR will often depend on the level of expertise and expense of the clerical staff. Steve Sherilla, M.D., a family practice physician in Butte, Mont., using QD Clinical, paid for the required hardware and software in less than one year, and was able to stop using a transcriptionist four hours a day when he became proficient with the system. Implementing a CPR Before requesting information from CPR vendors, you must understand the unique needs of your practice. There must be "data rewards" you can gain from the system, such as outcomes information, and not just data input. "To automate without planning and reengineering will only result in the same inefficiencies of a paper-based system," insists Gary Juran, president of CPR Solutions, Inc. And strategic planning is critical. Mary McHugh, an associate professor in the Nursing Informatics Program at Wichita State University puts the percentage of planning time at 50 to 80 percent of the total project time, "the project being defined as preparing for, purchasing, installing the system, training the people to use it, and finally, evaluating the system's initial performance." Beyond the administrative cost savings, industry experts agree that perhaps the greatest advantage of a CPR is the ability to generate financial and clinical outcomes data. In fact, they warn the initial cost savings may be marginal and should not be the sole reason for choosing a CPR system. Clinical outcomes generated using a computerized patient record will empower the physician community and help providers achieve their final goal -- optimizing the quality of patient care. Written by: Mark R. Bard\ CPR Software Vendors
HealthPoint - HealthPoint ACS
IDX - Clinical Management System
MedicaLogic - Logician
Systems Plus - Medical Manager
Health Care Data - Health Probe Information Manager
STAT! Systems - Q.D. Clinical
Oceania - WAVE Electronic Health Record
Medic Computer Systems- AUTOChart
Medcom Information Systems - Welford Chart Notes |
Anyone who has seen the medical records room of a large group practice knows how far the health care system still has to go to get on the information superhighway. Although the interest in computer-based patient records (CPR) has been growing for many years, it has in most cases remained just that - an interest.
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