Behind the Wires
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On his well-traveled speaking circuit, James Morrow, MD, can wax eloquently—and tirelessly—on the clinical and quality merits of electronic medical records systems. But ask Morrow why his own practice, North Fulton Family Medicine, adopted clinical IT, and he’ll be far more prosaic. “I would love to say we adopted an EMR to take better care of patients,” says Morrow, the vice president and chief information officer at the 10-physician practice in suburban Atlanta. “But it was a financial decision. We were inundated with bills, our fees had been cut repeatedly by payers, and the 100 patients a day we were seeing was all we could do. If we stayed as we were, we were going out of business.”
In the fall of 1998, North Fulton (then a five-physician family practice) invested about $250,000 in hardware and software for an EMR package from HealthMatics (later acquired by Allscripts) that eliminated the need for transcription, saving some $100,000 annually. The group also saved $140,000 in reduced labor associated with paper charts. Productivity skyrocketed, and by the end of 1999, the practice was treating 140 patients a day. “We were convinced in no time we made the right decision,” Morrow says.
Since then, North Fulton has doubled its number of physicians, now handling nearly 80,000 patient encounters annually. New features added to the EMR facilitated the expansion, Morrow says, including a lab interface that allows results from its two local labs to flow directly into the electronic chart, rather than across the fax machine. Four years ago, the practice added a patient portal, enabling appointment requests, secure messaging with the medical staff, and retrieval of health records. Some 29,000 patients have registered. Last year, the practice bolted on an e-prescribing module that hastens both new prescriptions and portal-driven refill requests. The system expedites delivery to patients and will create a track record of fulfillment, Morrow says.
In addition to pumping new life into the group practice, the EMR seems to have revitalized Morrow’s career, as well. “When I saw what it could do for physicians and patients, the technology sparked something in me.” Morrow has become an IT proselytizer, lecturing on the trade show circuit, testifying before government agencies, and participating in industry groups.
1. Electronic referrals
The lab interface only whetted Morrow’s appetite for connectivity to healthcare information trading partners. The future, he insists, rests in opening up the office to the outside world. His first connectivity project centers on referrals. Morrow estimates that North Fulton does some 25,000 annual referrals to multiple specialists, “everything from moles to heart problems.” And the more it can conduct the transactions electronically, the better everyone will be served, he says. Like other medical groups, North Fulton contends with a referral system that is an ad-hoc blend of phone, fax and prayer. “Somewhere in the world is a mountain of faxes that nobody gets,” Morrow quips.
But Morrow has good business reasons for wanting electronic referrals. “My malpractice carrier told me that if I send a patient to the cardiologist and the patient doesn’t go, I’m liable. I’d like to be able to look at the chart and see what referrals are complete, just like we do with labs.”
His EMR software does not enable referral transactions, so Morrow is working with a local IT consultancy, Novo Innovations, to develop a Web-based tracking system. A beta test with Northside Hospital in Atlanta is the next step, and Morrow has identified three physician practices affiliated with the hospital to be the guinea pigs. One practice is using the same EMR as North Fulton, another is automated with a different vendor, and the third has no EMR. “All they’ll need is a computer and a Web browser,” he says.
Morrow is optimistic that the local company can write a program to fulfill the basic needs of the players. “Every doctor would love to know if their referrals have been completed,” he observes. “But in the paper world, and even in this preliminary electronic world, there is not a way to do it.”
2. Community connectivity
Morrow’s second project extends his first, although he concedes that his idea for broad community connectivity is “as much vaporware as anything.” Morrow envisions a multi-county grid where various healthcare organizations would be commonly connected. He likens the idea to Napster, the music-sharing Web site that ran afoul of copyright laws. Morrow cheerfully concedes that he “stole” music using the service, whose root idea he says can be applied to healthcare. “The grid would allow you to treat healthcare the way I used to treat Napster,” says Morrow. “You could find music files off anybody’s computer with the Napster network, and anybody could connect to it. That is the way healthcare should be going.”
In Morrow’s grid, a user could post a request for data pertaining to a given patient. “That way, when the cardiologist changes the meds or the patient goes to the ED, I can know,” he explains. “Working in this closed system of the doctor’s office is not enough anymore. We’ve got to know what is happening when the patient is not in our office.”
Morrow’s idea resembles the regional health information organizations that now dot the national map. At this stage, he is “evangelizing about the idea” to anyone who will listen, including medical societies, local physicians and nurses associations. The idea is a bit quixotic, he concedes. “It is very much in its infancy, but in the long-term, this would be one of the most worthwhile things to do.”
The value of the data exchange, Morrow continues, rests in its ability to reduce costs and improve care. Every Monday morning, he says, patients come to primary-care clinics like his to let their physicians know they were in the emergency department over the weekend. Morrow recounts the typical conversation as a frustrating exercise in extracting clinical information. “They’ll come in and say they were in the ER for pneumonia. I’ll ask what they did. They’ll say, ‘lab and X-ray.’ I’ll say, ‘What did the blood count show?’ They’ll say, ‘I don’t know.’ I’ll ask what the X-ray showed. They’ll say, ‘That I have pneumonia.’ Well, I know that, so I’ll ask, ‘Where is it?’ And they’ll say, ‘It’s in my lungs.’ At that point, a nurse has got to go get all that information for me. It’s not easy to sort out.”
Invariably, Morrow says, the physician will order additional blood work and X-rays just to make sure the patient is not getting worse, repeating tests that were done within the previous 72 hours. “You could feed a small third-world country on the money wasted,” he says. “People show up and you can’t get the result, so you just repeat the test.”
Even though he has no timeline for the community connectivity project, Morrow’s convinced of one thing: the need for the technology is not going to disappear soon. His next step: soliciting payer support. “They are paying extra money for these tests,” he says. “They could spend a fraction of what they are spending now and solve these problems.”
Morrow’s third project will bring additional connectivity to North Fulton’s practice sites. The practice has invested some $400,000 on computerized radiography equipment in three of its locations and an adjoining picture-archiving system from Kodak. The practice does a small number of images, predominantly of chest, lung and spine, which it has historically acquired with conventional film processing. With the computerized radiography equipment, the practice can quickly convert images to digital format, eliminating the need for film storage and processing. Morrow himself orders half a dozen X-rays a day. The practice usually reads its own films, he says, but may courier some images to a local radiology group.
In the next phase of the project now under way, the practice sites will be connected to the PACs server, enabling the sharing of images across remote locations, including the local radiology group. “The goal is to create a searchable repository of all images,” Morrow explains. “Right now the images are stored in individual servers in each office.”
In comparison to his first two projects, the PACS project is smaller and should be easier to complete, he says. Of course, with nearly a decade of clinical IT under his belt, Morrow has a much different perspective on such issues than the majority of physicians.
Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at firstname.lastname@example.org.
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