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Tuesday, October 16, 2012

My E.H.R. Experience: A 15-year Journey


I have been using an E.H.R. off and on since the mid-1990s.  At that time, I was using the VA Medical Center’s system, VISTA.  Few current commercially available systems today can compare to what VISTA had in functionality back in 1999.  It was truly a fantastic system and it became for me the gold standard by which all other systems would be compared.

From July 2001 to April 2006 I went back in time, leaving the electronic world for the world of paper charts and DOS based billing systems.   I think this experience—living in both the paper and electronic worlds--taught me that medical offices run best in a digital environment.   Medical practice is too data-rich and high volume data is best managed in a digital format.  It is just that simple. 

In 2006, I left the paper world and returned to the digital one.  When I opened my own practice, I wanted to be electronic from day one.  The only problem was that I could not afford systems.  In addition, like many members of this IPA, I did not see the value in paying up to $40,000 for software.  That just seemed crazy to me, and in a way it still does.  So I built my own homegrown EMR system

I can tell you that my homegrown system was terrific and better than any paper system I ever used.  I used templates and macros and electronic faxing.  I set up in-bound lab interfaces so I never had to scan labs into my system.  I could retrieve patient charts in microseconds, rather than the days it would take to locate a chart in my old practices that were still on paper.  And I could access my charts from home or away.  The cost was the best part: a couple hundred bucks.  All software was commercially available, off the shelf, and general use.   So why the hell did I change? 

By 2008, my practice had outgrown the capacity of my system.  What worked with a volume of 35 patients per week no longer worked at 65 patients per week.   I grew tired of tinkering with my homegrown system.  Not only was I the developer, I was the IT support specialist, trainer, network engineer, and troubleshooter all wrapped into one.  I really just wanted to be a doctor and to be able to focus on patient care and growing the practice.   Plus I was swimming in post-it notes and drowning in pharmacy related issues.  To add to the stress, 2007 saw the advent of the RAC era.  At a moments notice, I could receive via mail an audit request letter for coding and compliance and potentially be liable for tens of thousands of dollars.  My system was just not equipped for any of that.   Finally, I had an EMR system and a separate billing system and they could not “speak” with one another.  So it was difficult if not impossible for me to do the type of practice analytics I needed to do to grow my practice.  I needed professional solution and I was finally willing to pay for it.

In 2009 I went live on my EHR and have never looked back.