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Capitalizing on an EMR

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One of the most frequently cited reasons for the under-utilization of clinical information technology by physician groups is that of mismatched economics. Spend the money, the thinking goes, and watch the benefits accrue to someone else. Several speakers at this year's TEPR (Towards the Electronic Patient Record) conference turned that notion on its head. Representing a range of practice sizes from the tiny to the huge, these speakers detailed how their groups had trimmed expenses, enhanced revenues, and expanded productivity by judicious use of clinical IT and other technological tools.

The Medical Clinic of North Texas, for one, boosted average revenue per encounter some 7%, from $115 to $123, according to Steve Neorr, chief operating officer. The increase stemmed from a combination of more accurate charge capture and participation in pay-for-performance initiatives. Although this 100-plus physician group of internists and family physicians had deployed an EMR in 2001, it wasn't until they hired an outside firm to consolidate and analyze their data measures several years later that they began to see the real return on the technology. The group receives "patient recommendation reports" from its vendor, CINA, on a daily basis. The reports highlight, for example, which patients are overdue for an appointment, or which patients are overdue for a certain test related to their diabetes. In essence, by practicing better medicine, the group has been rewarded economically.

On the expense reduction side, other practices have put technology to work replacing traditional medical transcription services with voice recognition. The Lifetime Health Medical Group, a 150-physician group in Buffalo and Rochester, NY, had seen its transcription bills hit $1.25 million annually. Since deploying voice recognition and enabling physicians to create their own notes, the group has seen its transcription expenses go down to about $200,000 annually.

"Voice recognition is faster than typing, and helps transition to using documentation templates," Douglas Golding, MD, medical director, noted at the conference.

The voice recognition technology helped the practice overcome some of the flaws of an EMR, namely its ability to streamline capture of the patient history and physical. Such critical pieces of the chart, Golding said, do not lend themselves to documentation templates, as they contain too much unique detail for a pull-down menu to accommodate.

James Saul, MD, said his three-member internal medicine practice in suburban Cleveland has boosted its fiscal return by deploying EMR technology. In Saul's case, reduced transcription costs also figured into the equation. In addition, the practice is able to support a higher level of E&M coding for its services, and also reduce its support staff. The practice lost one medical assistant through attrition, finding it did not need to maintain extra labor to do chart pulls once it went to digital files.

Although these three practices improved their operations, they all took different approaches to their deployments. Sometimes it is the smallest features—such as a lab interface that imports results directly—that provided the biggest selling points to the medical staff. As the industry compiles more case examples like these, additional medical groups will likely be tempted to take the plunge to electronic record keeping.

—Gary Baldwin

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