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.
