Paperless from the get-go: EHRs’ efficiency, care benefits win over NY DO

Family physician Anna M. Lamb, DO, never even gave a thought to using paper records in her western New York practice.

After graduating in 1996 from Kirksville (Mo.) College of Osteopathic Medicine-A.T. Still University, Dr. Lamb joined a group practice. As with many physicians, she and her colleagues relied on notepads and charts to record every patient visit, diagnosis, recommended treatment and prescription—each document eventually filed in a growing collection of crowded cabinets. “The required paperwork was very cumbersome,” Dr. Lamb recalls.

In 2004, when she opened a solo practice in her hometown of Batavia, N.Y., Dr. Lamb severed ties with paper. “I decided to start my practice from day one with electronic health records (EHRs),” she says.

Starting clean

As the new physician in town, Dr. Lamb could learn to use her new EHR system as she slowly built her practice. “At the start, I was seeing six or eight patients a day, so I had time to play with the program,” she says.

With the help of her vendor, Dr. Lamb customized the EHR system so her patient charts, for instance, would include shortcuts to templates on lab work, patient history and medical decision making. The simplified access enables Dr. Lamb to bypass the labyrinth of templates other physicians sometimes encounter in EHRs. “I’ve been able to make this system very easy for myself,” says Dr. Lamb.

The biggest challenge for Dr. Lamb was helping staff adjust to the EHR workflow. “People who had been employees in other medical offices had to change some work habits,” she says. For example, while lab results in other practices typically arrived by fax, at Lamb Family Medicine they pop up in the computer system and have to be entered into a patient’s electronic chart. “Staff used to put messages on sticky notes and attach them to a patient chart, but now they have to do it all on the computer,” Dr. Lamb says. She estimates it took about three months for her staff to use the electronic system proficiently.

Office and clinical benefits

Once her staff was familiar with the EHR system, its benefits—in terms of office operations and patient care—became apparent, says Dr. Lamb. Using either a laptop or tablet computer during patient visits, Dr. Lamb clicks through the EHR exam chart and types in treatment recommendations and other needed information. “My nurse and I each spend about 10 minutes with each patient,” she says. “My productivity is high, about 32 patients a day, because I’m moving right along. Yet I still have time to ask patients about their grandkids. A benefit of my computers is that I can keep them on my lap, like a chart, so I can face the patient as I enter data.”

The EHR system includes an evaluation and management calculator that alerts physicians when they’ve chosen an incorrect Current Procedural Terminology (or CPT) code for a patient visit. Also, with most patient information a click or two away, less time is wasted searching for misfiled lab reports and other data.

One of the biggest clinical advantages of Dr. Lamb’s EHR system is its ability to ensure accurate prescriptions, she says. Automated data entry precludes problems with illegible scripts. The system also informs physicians about proper drug dosing, possible drug interactions and generic drug alternatives.

In addition, the EHR system includes a template for osteopathic manipulative treatment. “I have a section for osteopathic exams, which is in a drop-down menu,” says Dr. Lamb. “It takes just a couple of minutes to document a head-to-toe exam and note the treatment.

“And I don’t have to document OMT in an 'other' menu selection. My software incorporates OMT into every progress note. So even if a patient doesn’t come in specifically for OMT, if I do a procedure it goes right into that person’s chart.”

The EHR, which is manufactured by Medent Community Computer Service Inc., also enables Dr. Lamb to scrutinize the clinical progress of various patient populations. “The company wrote a program for me that I use to learn, for example, how I’m doing overall on control of patients with diabetes mellitus,” she says. “The program tells me my diabetic patients’ average disease hemoglobin A1c. And when I run it every few months, I can see if they’re doing better or worse.”

Interoperability, patient portals

Within the next few months, Dr. Lamb anticipates her office will be connected to a health information exchange, which will enable the practice to electronically link with regional hospitals, other physicians and labs. When that occurs, incoming data should instantly be delivered to patients’ charts, eliminating the need for staff to manually enter information.

In addition, plans are under way to add a patient portal to the EHR system by April. This will enable patients to enter and update personal data from their home computers. For Dr. Lamb, it will also be a speedy vehicle for educating patients and notifying them of needed tests.

“Among the nice things about EHRs is that you can do a lot of population management,” she says, adding that she anticipates future improvements will increase her office and clinical efficiency. Looking back on her days in a “paper practice,” she says, “I couldn’t imagine practicing as a solo physician without EHRs.”