Paperless chase

MGMA Connexion, Aug 2004 by Shein, David, Goodwin, Tom

MIT Medical uses EMR to improve care delivery process

Massachusetts Institute of Technology (MIT) Medical provides health care services for MIT students, retirees, employees and their dependents. The practice has two locations and is affiliated with many of the major teaching hospitals in the Boston area. MIT Medical, with 24 full-time physicians, 50 part-time physicians and 275 clinical and administrative staff, serves more than 23,000 patients annually.

MIT Medical faced common problems in providing quality health care to its patients:

* Physicians and staff frequently waited for the delivery of a paper chart or spent valuable time calling staff or associates to locate patient information;

* Dictated paper documents and lab results often took weeks to reach patients' charts;

* The paper filing process did not ensure that the most recent information was available in the chart when the physician saw the patient; and

* Manual processes led to frequent inefficiencies, such as delays in returning patient phone calls, missing dictated notes and subpar patient follow-up.

An EMR as a solution

MIT Medical implemented an electronic medical record (EMR) to solve these problems and reduce the risks and costs associated with managing patient care via paper charts. Senior management recognized that such a move would have to demonstrate direct benefits to physicians and staff early in the implementation process. They knew that to become a paperless organization, the clinical system must work seamlessly with MIT Medical's scheduling, registration and billing system.

The organization chose an EMR that interfaced with existing software and with other systems, allowing for growth. The product offered a modular implementation strategy, which facilitated the EMR's use by physicians. MIT Medical's leadership implemented document management functions and laid out a plan to adopt the EMR and a paperless office over time.

MIT Medical identified goals for its EMR implementation:

* Improve timely access to clinical information for physicians and staff;

* Improve patient and staff satisfaction;

* Enhance communication between physicians and support staff and with patients;

* Increase patient safety to reduce the chance of errors;

* Eliminate unnecessary paper processes;

* Reduce costs and improve process efficiencies; and

* Improve outside correspondence processes.

Results meet expectations

The EMR allowed providers to obtain information immediately from their offices, the hospital or at home. Integration with the practice management system provided instant access to patient scheduling and demographic information. The EMR's workflow and tasking engine enabled MIT to redesign the care processes and improve the associated workflow.

MIT Medical has documented a reduction of 45,000 chart-pulls per year throughout all departments. At a cost of $4 in labor and supplies per chart-pull, MIT saved $180,000 in its first year and projects $900,000 in savings over the next five years (see box). The organization reduced chart-pulls in the Urgent Care Department by 93 percent in only three months.

The EMR has enabled MIT Medical to print 9,000 fewer clinical documents per month and file 25,000 fewer documents in the paper chart. As a result, the practice has eliminated 2.5 full-time-equivalent positions through attrition. Additionally, the number of paper-medical-record requests by providers for patients without an appointment has dropped by more than 60 percent. Clinicians now document more than 3,300 patient phone calls per month without the need for duplication in a paper chart.

MIT Medical implemented the workflow/ tasking, document management, results viewing and clinical database repository capabilities of the EMR. These functions:

* Enabled physicians to view online all transcribed notes, patient lab and radiology reports;

* Provided the ability to sign notes and laboratory test requests electronically;

* Allowed faxes to be sent directly to referring physicians from the online database;

* Reduced the cost for chart-pulls, transport and filing;

* Eliminated the need to print paper transcribed notes; and

* Eliminated multiple charts for the same patient.

Rapidly implementing an enterprise-wide solution to workflow problems yielded immediate benefits. This success helped MIT Medical's senior management gain support to roll out additional modules.

MIT Medical has recently implemented the EMR's e-prescribing capabilities and writes 1,300 electronic scripts per month, resulting in improved patient safety, a reduction in pharmacy callbacks and a paperless medication management refill process.

To further reduce the need for paper in the practice, MIT will implement the EMR's document imaging function. The practice is rolling out the clinical documentation capabilities of the EMR in an area with rotating physician coverage. The broad capability of the EMR will provide physicians the ability to practice outcomes-based medicine through the real-time capture and reporting of patient care.