Chartlogic Case Study
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The Decision
With today's challenges facing medical practices including government mandates, lower reimbursement and cost risk management, the physicians and administrator at Dover Orthopaedics needed a better alternative for managing patient charts. So in 2001, administrator Marilyn Orr set out to find an electronic medical record system (EMR) for her four-physician practice. Another administrator, who had been through the same experience, had given Marilyn some advice. The administrator advised her to "respect the culture of your group and understand what they are willing and able to do." With this advice and the list of practice objectives, Marilyn began her search.
Marilyn knew that converting her physicians to an electronic medical office would be as challenging as finding a system they would actually use. "Paper charts are our physician's choice by training and they seek streamlined processes. However, they are fully aware of the weaknesses with paper chart management;" said Marilyn. "For example, we might have had a patient test result faxed to us on Tuesday. At Thursday's appointment, the test result had completely disappeared and needed to be re-faxed lengthening the patient encounter and tying up resources and then miraculously turning up at a later date. The staff often speculated that it had spent the lost time in the trunk of the physician's car."
At the time they began searching for an EMR, Dover Orthopaedics decided to also evaluate the value of the practice management system they had been using for nearly twelve years. They determined they needed to start with a clean slate and purchase both a new practice management system and an EMR. "At the time we started looking around for an EMR, the trend seemed to be practice management systems partnering or developing their own EMR system," explained Marilyn. "I couldn't find a solution that offered both a strong practice management system and a strong EMR, so we went back to the drawing board and carefully evaluated our priorities as a practice. We determined that it would be in our best interest to find the best EMR in the marketplace, and then find a practice management system that would complement the EMR."
After an exhaustive search, Marilyn determined that ChartLogic would be ideal for the four physicians at Dover Orthopaedics. Because their physicians ranged from "highly technical" to "never touch a keyboard," ChartLogic was the right solution for allowing the physicians to adapt to the system, as they were ready and at their own comfort level. Once the decision had been made to implement ChartLogic, Dover Orthopaedics chose GE Centricity for their practice management system. GE Centricity supplied the interface kit needed to integrate functionality with ChartLogic, but ChartLogic, Inc. was instrumental in getting the interface to perform seamlessly.
The Transition
In March 2003, Dover Orthopaedics completed installation and training for ChartLogic. To ensure that employees used the system to its full capacity, Marilyn had all standard and hospital forms used by their practice converted to electronic forms in ChartLogic. The practice immediately saw the results of converting their forms-physical therapy, laboratory, imaging, referral and surgery orders could be easily created, given to patients, retained for compliance auditing and faxed to outside vendors (if the order was misplaced by the patient). Prescriptions were generated through the system and documentation maintained that fully satisfied the Ohio State Board of Pharmacy.
The transition to electronic charting was easier for the physicians at Dover Orthopaedics because ChartLogic mirrored their original charting styles. "The most technical of our four physicians was completely up and running with ChartLogic within about three weeks," said Marilyn. "When his transcriptionist took a vacation, he completed the mastery of the process and she was happy to retire. He started slowly with easy revisits and quickly moved to mastery of more complicated consultations and initial visits." Within a year and a half, all physicians were successfully using ChartLogic to complete 100% of their charting. Just as Marilyn had hoped, the flexibility of ChartLogic enabled each physician to transition, as they were ready.
The Results
By July 1, 2003, Dover Orthopaedics transitioned to seeing patients with the chart available if the physician needed it. By August 15, 2003, chart pulling stopped. Within a month, all charts had been moved to permanent storage and the space converted to office space for two billing staff who previously worked out of the office lunchroom and their own homes.
"Since the implementation of ChartLogic, neither of the people who made up the 1.75 FTE transcription positions is with us," Marilyn said. As new patients contact the practice for appointments, the telephone staff uses ChartLogic to enter the background information needed to create a medical record (patient medical and social history, allergies, prior surgeries, medication list and family history). When patients arrive for their appointment, they review a pre-populated form that includes this information and asks less than five questions about their condition status on that day. "Having electronic patient information has greatly improved satisfaction among our patients," said Marilyn. "We can get them in and out of the office more quickly with less paperwork, plus, the information we have in our records is much more complete and easily accessible." Marilyn believes that ChartLogic has given her practice more efficient use of their resources, their personnel and their patients.
Another result the physicians are benefiting from is remote access to ChartLogic. "Our physicians have been particularly pleased with the ability to work from home or on the road," said Marilyn. "ChartLogic gives them complete access to all patient information including prescriptions, whenever and wherever they are."
The Bottom Line
Implementing ChartLogic has improved the bottom line at Dover Orthopaedics in several ways. "Because ChartLogic enables us to use our resources and personnel more efficiently, we have increased the number of patients we can see by 8-10%," explained Marilyn. "In addition, our accounts receivable is down 20% because we can collect faster with better documentation." Marilyn also noted that proper documentation combined with more appropriate coding has resulted in fewer appeals and quicker reimbursement.
Dover Orthopaedics has also seen a significant decrease in charting and office supplies. Before using ChartLogic, Marilyn estimated that 10-15 new paper charts were created every day. The cost to make each chart averaged $2.25, which included labels, label protectors, charts, and chart inserts. The elimination of paper charts is saving Dover Orthopaedics over $7,000 annually. In addition to new charts, the dictation used to be printed on a costly, label-type paper and manually transferred to the chart once signed by the physician. The practice's use of outside printing resources has dropped to virtually nothing besides envelopes. The cost for fax paper has also been reduced because the faxes are received through the computer and pertinent documents are imported directly into ChartLogic. A good number of faxes are unsolicited and do not even need to be printed; they can be routed through the system and deleted without the cost of paper and toner. An additional savings was in the reduction of overtime. A comparison of the six months prior to implementation, with the same period one year later showed a 50% reduction in overtime for the administrative staff. They attribute the savings to process flow reduction, document management and prescription functions within ChartLogic. That savings far outstrips anything saved through material.
An Unexpected Benefit
In September of 2004, Dover Orthopaedics had an opportunity to put ChartLogic to the test when the Vioxx® recall was announced. ChartLogic enabled them to instantly generate a list of all Vioxx® patients. "Within two weeks of the recall, every patient who had ever been given a Vioxx® prescription or sample had been contacted with information about the recall," said Marilyn. "We advised our patients to make an appointment so we could find an alternative treatment and provide information on requesting refunds." Dover Orthopaedics did not have the resources to provide this type of proactive care for their patients prior to the use of ChartLogic and they are proud they could address this potentially life-threatening issue so quickly.
