A Ten Year Experience with EMR: Grossmont Family Medical Group

Joseph F. Leonard, M.D.

November 18, 2004

1.  Information about our office

  1. Size of practice
  2. 72 computers
  3. 8 providers
  4. Website (www.gfmg.net)
  5. FAX messages from website to office
  6. experience with patient-MD e-mail

2.  Making appointments

  1. Requires telephone call
  2. Web-based scheduling
  3. Would require secure hosting of our EMR by our software provider – at a cost
  4. reminding patients of visit
  5. installing software that links to the scheduling program
  6. patients able to cancel appointments
  7. office reviews responses early each morning

3.  Seeing patients

  1. Paper superbill
  2. Unfulfilled electronic encounter form
  3. Poor pull down ICD-9 code list – non-intuitive abbreviations
  4. CPT codes would have to be pulled down

4.  ordering lab

  1. paper requests currently
  2. electronic ordering from independent lab via “e-bridge”
  3. electronic ordering through EMR
  4. unfulfilled
  5. requires additional module
  6. would track tests ordered but not yet received

5.  receiving lab and xray

  1. our hospital
  2. ten year trial to get an interface
  3. each information flow requires an interface
  4. hospital has three separate information interfaces
  5. they thought they had two

a.  imaging text

b.  laboratory results

c.  pathology texts

  1. commercial lab
  2. greater experience with interfaces nationally
  3. able to set up the lab interface with our EMR quickly

6.  Billing and Collections

  1. Initial DOS system with separate database than EMR (same company)
  2. Upgrade to Windows
  3. But all the demographics do not always update
  4. Complex posting
  5. not as efficient as stand alone billing system
  6. many glitches
  7. billing “licenses”
  8. annual fee for each person using a module
  9. having to pay limits how many people are allowed to bill or schedule
  10. sending out statements
  11. proprietary encryption of HCFA forms to Medicare carriers
  12. transaction or global fee to software carrier
  13. then to a web-based clearing house
  14. then to payor
  15. IPA statements
  16. currently paper based
  17. to continue with current billing module, would have a per-bill fee + additional cost for softward
  18. receiving payments
  19. Medicare directly deposits funds into our bank account within 14d
  20. BUT, takes a long long time to post payments
  21. need to compare ease of posting between systems

a.  can really eat up a lot of billing personnel hours that could be better spent in working on collections

7.  Provider review of tests

  1. Lab files
  2. Generation of patient notification letters
  3. Text imaging and lab data
  4. Pending – third data stream for Hospital text data
  5. History and Physicals
  6. Discharge summaries
  7. Procedure notes
  8. Currently, these have to be scanned in

8.  Provider review of outside medical information

  1. Letters from consultants
  2. Hospital text data
  3. Paper sent to provider
  4. Provider dictates summary
  5. Paper then scanned into chart
  6. then shredded

9.  Vendor “lock-in”

  1. E-billing of Medicare and other third parties
  2. Proscribed encryption
  3. makes bills have to go to EMR software headquarters for de-encryption
  4. transaction fee charged by EMR software company

10.  Office information system specialists

  1. Employment of a network specialist
  2. Hourly payment
  3. Contracted payment
  4. Current “to-do” list”
  5. work with hospital and EMR to get third data stream
  6. telephone reminder software installation
  7. electronic prescription transmission
  8. installation of new billing software program
  9. keeping viruses off our system
  10. constantly changing employees

a.  adding and deleting access

  1. maintaining e-mail system
  2. system HIPAA compliance
  3. current EMR difficulties with electronic transmission to Medicare
  4. setting up receiving FAXes from consultatants

a.  instead of printing from FAX, making a data file

b.  transferring the file into the chart for review

  1. medical records personnel
  2. Director of Medical Records
  3. helpful position – fulltime practitioners do not have the time
  4. arranging software upgrades
  5. interfaces directly with network specialist
  6. HIPAA compliance officer
  7. referrals specialists
  8. linkage with IPA for paperless referrals
  9. separate electronic system

11.  Accounts payable

  1. Paper bills received
  2. Commercial accounting program – no linkage to EMR
  3. Electronic payroll