All Island Gastroenterology
All Island Gastroenterology & Liver Associates, P.C. (AIG), was established in Long Island, NY in 1997 as a two-physician single specialty practice. By early 2009, the practice was serving more than 20,000 patients, and AIG’s paper charts and financial documents were occupying a significant amount of physical space within the practice’s 2800 square foot office. Files for active patients were stored within the front desk area, while archived patient files and the practice’s financial records were stored in a vacant office and various storage areas throughout the practice. At that time, AIG had an operational EHR system, but patient records were being scanned into the system at a very slow pace.
After more than a decade of patient service, AIG was going to expand significantly due the upcoming addition of a third partner in a merger of practices. There were already challenges finding medical records files by hand, so AIG decided to upgrade its health information technology (health IT) system to more fully utilize its capabilities.
The decision was made in February 2009 to adopt an additional technology partner to jumpstart the document scanning process. Their technology partner provided two major solutions to AIG:
- by quickly and efficiently converting the incoming physician’s 18,500 charts and AIG’s existing archived patient and financial records into an electronic format before the merger, the technology partner alleviated the need to move the incoming doctor’s patient records into AIG’s office space, and freed up an extra office at AIG for the incoming partner
- by adding an interface to the existing EHR, all of the scanned patient files and financial records were immediately available via a secure internet connection to the AIG servers. This immediate and easy access to the patient records impressed even the most skeptical physicians and staff members.
One year later, the physicians and staff continue to recognize the efficiency and improvements in quality of care as a result of immediate access to patient records, be they on-site and off-site. The ease of accessing a patient’s medical record using the EHR system remotely allows the on-call physicians to respond more accurately during off hours emergencies. The need to drive to the office, hunt for the patient’s records, and then return the emergency medical provider’s call is now completely eliminated as a result of remote access to the EHR system. Those realizations converted the doctors into supporters of the technology. “That was their ‘Aha!’ moment,” says Michaela Faella, Practice Manager of AIG. Faella says the process of implementation “empowered everyone… even some of the most unlikely staff members have become the best at utilizing the EHR.”
AIG’s physicians treat patients with a variety of ailments and diseases, some of which may require an organ transplant. Recently, one of AIG’s recommended transplant patients called to request the transfer of their medical records to a local hospital because they were notified of a liver available for transplant. The transplanting hospital needed immediate access to the patient’s medical history. With the patient’s authorization, the records were securely and electronically transferred from AIG to the transplant physician—the turn-around time from the initial phone call to the records being transferred took only minutes. Without the EHR system, the records transfer authorization and document transfer would have taken significantly longer, as teams on both sides would have struggled with multiple phone calls to one another and the cumbersome task of faxing a multitude of medical records pages. The EHR system allows for urgent medical matters at AIG to be handled accurately and expeditiously.
In addition to the emergency response efficiencies, practice growth over the past year and increased inner office efficiencies as a result of the EHR upgrade allow AIG physicians to see an average of 25 more patients weekly. With a $45,000 investment in upgraded health IT systems and the addition of the third physician, the practice has been able to increase revenues by 50 percent. In addition, the upgrade has gained AIG 4,000 hours of staff productivity, valued at $100,000 annually.
In the near future, AIG hopes for EHR system interoperability with additional local medical facilities’ EHR systems. Other plans include a secure online portal where new patients can register themselves prior to visits and manage appointments, with the portal ultimately linking back to the patient’s EHR record through the practice management software.
When she reflects on the adoption of an EHR system into the practice, Faella offers the following recommendations when working with a health IT vendor:
- Recognize how applicable and scalable the product is to the practice. Many EHRs have numerous features that are not required or are not configured specifically for a specialty practice.
- Learn the possibilities for paper chart conversions that allow the practice to continue to function while the scanning is being done either on- or off-site.
- EHRs systems often rely on external software programs – make sure the interfaces between all programs have been tested and work together properly. Ask the EHR vendor for references of practices that have completed similar conversions.
- Do not make the driving factor for EHR adoption the (Medicare/Medicaid reimbursement) incentives; the driving factor really is practice efficiency, which ultimately lowers healthcare costs.
- Make sure to follow state mandates regarding paper versus electronic health records.