Practice Partner User Profile -- Return on Investment

Westshore Family Medicine serves the community of Muskegon, Michigan, a city of 42,000 situated on the shores of Lake Michigan. The practice includes seven physicians, two physician assistants, and one nurse practitioner. They have 21 examination rooms and receive 2,400 patient visits per month, and are also a member of a local network comprised of 13 family practices and 50 providers. In 1995, Westshore was the site of a pilot project to determine if an electronic medical record (EMR) could replace the paper chart.

So Westshore went shopping for an EMR. According to Dr. Michael Banka, "We wanted to make our lives easier and improve patient care. We did a thorough search of the EMRs available and decided on Practice Partner Patient Records because of its ease of use." Patient Records was installed in January 1995, and no paper charts have been kept since then. The project was successful; Patient Records not only replaced the paper charts but also allowed the staff to work more efficiently. This greater efficiency has reduced costs, reduced stress, and improved patient care.

Greater efficiency has led to decreased staffing needs and decreased transcription costs. At Westshore, there are 2.5 staff per full-time provider; at similar family practices without an EMR, there are 3.5 staff per full-time provider. Handling paper charts consumed a great deal of staff time. As Bea McLain, the office manager, explained, "Every day there were so many charts needing to be pulled and filed. It amazed us how much time we had been spending handling paper charts and looking for missing charts. Not having to hunt them down freed up so much time for everyone. The frustration level went down considerably."

Before the implementation of Patient Records, progress notes were dictated and transcribed with a turnaround time of seven days. Notes are still dictated, but with Patient Records they are transcribed with a word processing program and downloaded into the patient record with a turnaround time of one day. Transcription time has been reduced by 33% since the implementation of Patient Records, even with the addition of two new providers. Not having to handle paper charts saves a great deal of time, but as Bea McLain commented, it's not the whole story. "When we were typing on paper charts we had to remove the page from the chart, type the note, and reassemble the chart. Even without the paper charts, transcription seems to go faster with Patient Records. Transcriptionists are able to concentrate on their work with fewer distractions."

Pharmacy costs have also been reduced since the implementation of Patient Records. Drug costing information, along with quarterly updates, is available from PMSI. When writing a prescription with Patient Records, the physician can easily check on the cost of a drug and, when alternatives are available, prescribe the least expensive. Using this service has made a big difference. Typically, HMOs (Health Maintenance Organizations) allocate a certain dollar amount per prescription. At Westshore, pharmacy costs average about $2.00 per member per month less than the allocation; similar practices without the EMR are about $4.00 over. Multiplied by 8,000 patients, the savings are considerable.

Patient Records is also an effective tool for improving patient care and enhancing revenues. By increasing the number of patients receiving recommended preventive services, such as immunizations and mammograms, patients receive the services they need and revenues are enhanced. The record is flagged when recommended services are overdue. When the patient visits the office, a reminder pops up on the screen when the record is accessed. There is also a screen that lists the recommended preventive services broken down by age and gender; overdue services are highlighted in a different color, making them very visible. Patient Records can also be searched, and patients needing services can be phoned or mailed a reminder to make an appointment.

The difference Patient Records makes in the number of patients getting preventive procedures can be dramatic. In Muskegon County, only 40% of women who should be getting mammograms get them. Among Westshore patients, the figure is 78%. More children are getting their immunizations. "We did a comparison between our office and another office without an EMR to see what percentage of kids had received their immunizations at age two," reported Dr. Banka, "37% of their kids and 94% of ours had been immunized. Only four kids in our office didn't have their shots. They were all updated by the end of the day."

What does the future hold for Westshore? Patient Records is still providing opportunities for increased efficiency and savings. For example, all Westshore patients requiring hospitalization are admitted to one of the local hospitals, and every week 600 to 700 pages of reports were received from the hospital. It took one full-time staffperson to scan all those reports into the patient records. This is now a thing of the past. A medical record interface has been established with the hospital and, in the future, reports will be downloaded into the record electronically.

Dr. Banka believes that Patient Records will also help Westshore recruit and retain valuable people. "Patient Records is a powerful recruiting and longevity tool. Everyone has become so accustomed to the EMR that they wouldn't want to work anywhere that doesn't have one. It's a good tool for retaining staff."