Medical Group Management Association (MGMA) 

Tech Talk: IT possibilities, challenges, resources

February, 2006

By James L. Holly, MD, MGMA member and CEO, Southeast Texas Medical Associates LLP, Beaumont, jholly@jameslhollymd.com

Southeast Texas Medical Associates LLP (SETMA), is a midsize, multispecialty practice with almost 40 providers and more than 250 employees.

When SETMA began in 1995, we had no uniformity in creating, filing or storing medical records. Some physicians dictated patient records, others handwrote them. Some organized records alphabetically, others used a numeric system. Our medical record-keeping illustrated all the problems facing health care in America.

By spring 1997, dictation and filing frustrations led SETMA leaders to discuss an electronic medical record (EMR) system. To learn about the technology, the practice's partners attended the MGMA 1997 Annual Conference in Washington, D.C., which offered programs on evaluating and purchasing an EMR. We dissected what we learned and returned to Texas determined to get the technology.

We've got an EMR - now what?

We selected and purchased a system in 1998, and the fun began. It was soon obvious that this was going to be harder than we thought. We had a product, yet still needed a solution to our record-keeping. But we were resolved to make the technology work for us.

We launched the fully integrated back-office system on SETMA's third anniversary. Simultaneously, we were developing the EMR database to support the clinical documentation solution. Today this step is superfluous, but in 1998, no "out-of-the-box" solution existed. We aimed to launch the EMR in November, but it would be Jan. 26, 1999, before we would see our first patient using the EMR.

That day - the longest day in SETMA's history - is burned into my memory. It began at 3 a.m., entering data into the records of patients to be seen that day; it ended 16 hours later when the last patient left.

Implementing the EMR an enormous challenge

We were told that the best way to implement the EMR was to limit the schedule of patients and begin with the last patient of the day. We didn't decrease the schedule and we began with the first patient of the day. The new technology and our unfamiliarity with the templates slowed us considerably. We got so far behind that first morning that we reverted to dictating our notes. In the afternoon, our information technology employees asked, "You're going to continue dictating, aren't you?" We replied, "No, we're going back to the EMR."

We finished the afternoon session two hours late. Four days later, we saw every patient in the clinic using the EMR. Over two weeks we achieved the same efficiency level we'd had pre-EMR, but with a growing ability to bring more information and functionality to each patient encounter.

What did we learn?

Two simultaneous events define our success with EMR. The first was our realization that this task was too hard and expensive if we only succeeded in documenting patient encounters electronically. We had to bring more knowledge, more data and more analysis to each encounter based on best practices and random controlled trials.

We began developing EMR functionality to enhance the quality of patient care, increase patient satisfaction and expand providers' knowledge and skills. In spring 1999, we adopted electronic patient management - and the investment of time and money was suddenly worthwhile. The EMR now allowed:

• Capturing and processing data, focusing on the development of disease;
• Auditing efforts to change those disease processes;
• Measuring the effectiveness of those efforts over time; and
• Evaluating the quality of patient care at the point of care.

The second event - in May 1999 - set the tone for the next six years of EMR implementation. In a moment of frustration with the EMR, which at this point was cumbersome to use and yielded little more than an acceptable record of a patient encounter, one partner said, "We haven't even begun to crawl yet." SETMA's CEO replied, "Yes, and if a year from now we're still operating at this level, I'll join you in your complaint. But I'm celebrating the fact that we're doing more than ever before."

Celebrating the successes

Ten principles guided SETMA's development of a database supporting our goals to:

• Pursue electronic patient management rather than EMR;
• Bring to bear on every patient encounter what is known rather than what a particular provider knows - so a patient won't receive inadequate care because the treating provider lacks information;
• Make it easier to do it right than not do it at all;
• Continually challenge providers to improve their performance;
• Infuse new knowledge and decision-making tools throughout the organization;
• Establish and promote continuity of care with patient education, information and plans of care;
• Enlist patients as partners in their care;
• Evaluate patient care and populations of patients longitudinally;
• Audit provider performance based on the Consortium for Physician Performance Improvement Data Sets*; and
• Create multiple, integrated disease-management tools to help patients manage their conditions.

A celebratory attitude has given SETMA the resolve to face hard times. The vision of electronic patient management has given us direction. We are on a pilgrimage to excellence that will never end.

*A joint venture of the American Medical Association, the Centers for Medicare & Medicaid Services, and the National Institutes of Health

SETMA a technology leader

In February, SETMA will receive the Healthcare Information and Management Systems Society Davies Award of Excellence for the use and implementation of health care information technology. In 2003, the practice was named the Microsoft Clinic of the Year "for the most innovative use of Microsoft-based products and tools in reducing costs, automating workflow and substantially advancing the healthcare practice through the best use of Microsoft-based products." Physician Practice magazine named SETMA the Southwest Regional Clinic of the Year in 2003 and in 2005 named SETMA a runner-up for national clinic of the year.

Learn more about SETMA's EMR experience at www.jameslhollymd.com. Go to "Your Life Your Health" and then choose "Medical Records."