This case study examines how Cape Fear Pediatrics researched and implemented CareRevolution, an EHR system from Electronic Health Systems. Having a completely paperless office has improved patient care by enabling the practice to easily participate in an asthma quality-improvement program, cutting time lost locating paper files and easing the transition to team nursing, one pediatrician said.
Like germs at a playground, paper files were all over the two offices of Cape Fear Pediatrics. Although the 11-provider facility used Allscripts-Misys billing and scheduling software, all patient records remained on paper, said Dr. David Hill, a physician at the Wilmington, N.C.-based practice.
"As we grew, we found [that] charts were frequently missing -- and, when we could locate them, critical information hadn't made it into them," Hill recalled. "It wasn't unusual to find a patient's master-problem list or immunization record on the floor, having fallen out of the chart. Staff ran all over the clinic, looking in various piles for missing charts."
This process, time-consuming and frustrating to staff and patients alike, led Hill, who had used an electronic health record (EHR) system at a previous practice, to research the software options for Cape Fear Pediatrics.
Defining the right EHR system criteria
Given the many regulations surrounding patient records and physicians' offices, Hill had a lengthy list of criteria for Cape Fear's EHR system.
- Vendors had to be certified by the Certification Commission for Healthcare Information Technology, or CCHIT.
- Products had to be entered in the annual contest -- Towards the Electronic Patient Record (TEPR)-- hosted by the American Academy of Pediatrics, he said.
- The EHR system itself had to be tied to the Systemized Nomenclature of Medicine, or SNOMED, and to MEDCIN, a point-of-care terminology for EHR developed by Medicomp Systems Inc., which includes more than 250,000 clinical data elements, from symptoms and history to physical examinations and test results.
"I began researching in earnest in October 2005, at the American Academy of Pediatrics annual convention," Hill said. "Many software vendors were exhibiting, and it was an efficient place to gather information and contacts. We estimated a 12-month timeline from there to go-live, which ended up being just about right."
After completing its exhaustive research, which included looking at prices and getting references from other practices, Cape Fear Pediatrics selected CareRevolution by Electronic Healthcare Systems Inc., a Birmingham, Ala.-based provider of practice management and EHR software.
The right EHR system gestation period
Rather than immediately roll out CareRevolution to all users, the practice kicked off the launch with its billing and scheduling functions. "After three months or so, we added progress notes, phone notes and internal messaging," Hill said. "Then we added orders and prescriptions. At nine months, we went fully paperless."
It wasn't unusual to find a patient's master-problem list or immunization record on the floor, having fallen out of the chart.
Dr. David Hill, Cape Fear Pediatrics
Two years later, Cape Fear Pediatrics has seen both operations and patient care improve.
"The two lowest-billing providers have improved their average billing substantially," Hill said. "We have been able to utilize automated reminders to make sure patients get flu vaccine, dental varnish and asthma action plans. We have also been able to participate in an asthma quality-improvement initiative that would have been much more labor-intensive without [electronic records]. Finally, we have gone to team nursing, which has increased our efficiency and on-time performance dramatically. Without the [EHR system], this transition would have been impossible."
Providing ongoing care with an EHR system
During its earlier stages, Cape Fear Pediatrics relied on Electronic Healthcare Systems to make multiple tweaks to the software to ensure each template best reflected the questions doctors asked and the exams they performed. "It continues to evolve organically," Hill said, "but now, two years into complete implementation, we seem to have a stable [EHR] system."
Physicians increasingly are willing to invest in and use software to streamline office operations, improve patient care and speed up insurance payments, Hill said.
"I would say, more than anything it is a doctor's increasing comfort with technology. We are in the midst of a generational shift from a generalized distrust of computers to a sense of trust," Hill explained. "If computers are better at doing your banking and reading a map, why shouldn't they improve your medical practice?"