Practice Partner User Profile -- Cardiology

Coastal Cardiology is an 8 doctor practice operating in 3 clinics. Like most practices, Coastal Cardiology had traditionally kept their patient information in paper charts. Although this system worked, the practice was convinced there had to be a more efficient means of managing medical records. " I recall watching 1 to 2 employees filing, disassembling, and reassembling stacks of paper charts on a daily basis in order to update them with incoming laboratory and hospital reports," recalls Michael Famularo, M.D., F.A.C.C. "I remember thinking that this was probably the way they were doing things back in 1920, and that there had to be a more efficient method."

After an extensive search, Coastal Cardiology decided to implement Practice Partner Patient Records. The physicians liked many aspects of Patient Records, including the long track history of successful installations (it was first introduced in 1987). Another aspect that impressed Coastal Cardiology was the program's versatility in meeting the needs of the clinic. "Practice Partner was flexible enough to accomplish the goals we had set for an electronic medical record (EMR) system," states Dr. Famularo.

With the implementation of Practice Partner Patient Records, Coastal Cardiology found an electronic chart that the cardiologists felt comfortable with. "We tailored Patient Records to look like our paper patient charts. With Patient Records's flexibility, customizing the patient chart was easy, " explains Dr. Famularo. Coastal Cardiology created special electronic chart tabs for EKGs, echocardiograms, surgery, and other cardiology-specific sections.

Coastal Cardiology approached the project with the objective of becoming paperless-that is, eliminating the need to pull and store paper charts. They have succeeded-and in fact have reclaimed precious office space that was once dedicated for paper charts. This has had a tremendous impact from both administrative and clinical perspective. For the front office, the biggest improvement has to do with chart access. No longer does the office staff have to hunt to find patient charts. Instead, patient charts can be accessed from any Patient Records workstation, reducing the time spent manually searching for charts. This is particularly useful with 3 geographically dispersed offices. Coastal Cardiology's three offices are connected by a wide area network (WAN), all linked to a central computer, so that all of their patient's charts are available from any workstation at any of the offices

This has had a major impact for the physicians as well. "When a physician calls in to discuss a patient, we can now answer the call immediately with the chart in front of us," notes Dr. Famularo. "With Patient Records, any patient chart can be pulled up in a matter of seconds, providing us with patient-specific information the instant we need it." The practice has become much more efficient in terms of its clinical documentation, since entire progress note can also be created and completed at the point of care. This allows patient data to be accessible immediately after the patient leaves. This has been particularly useful for documenting the routine non-invasive tests that are a standard part of a cardiology practice. "With treadmill work-ups and stress echocardiograms, data entry can be accomplished in the procedure room, providing a complete chart when you are done," notes Dr. Famularo.

Coastal Cardiology is also utilizing Practice Partner Patient Records as a means to improve the efficiency and timeliness of their communication with referring physicians. Using fax server technology (which allows documents to be sent directly from Patient Records to a referring physicians fax machine), the group is able to fax progress notes, test results, and other clinical communications to primary care physicians immediately after the visit-without the traditional paper handling chores that are typically required for this task. The improvement in efficiency has allowed the group to bring on 2 additional physicians-without increasing administrative head count.

Every one of Coastal Cardiology's 8 different physicians approaches documentation in a slightly different manner. Even with 8 different styles, Practice Partner Patient Records is diverse enough to accommodate every physician's style. By utilizing direct entry or dictation, each physician is able to create progress notes in a timely manner, while simultaneously updating the complete patient chart. And for those physicians who employ direct entry, Patient Records provides a host of features to enhance data entry, including clinical templates, clinical macros, and free form text. "It's been easy to customize the system to each of the partner's needs."

Since converting to Patient Records, Coastal Cardiology's record keeping quality has improved exponentially. Dr. Famularo explains, "Patient Records gives us the ability to monitor our physician's documentation habits. We can now tell who is up-to-date and who is not, which has provided us with an outstanding tool to keep physicians who are chronically late, up-to-date in completing their documentation."

An important feature for the charts at Coastal Cardiology is the ability to store images. "Specializing in cardiology, we deal with numerous images for each patient," explains Dr. Famularo. "Patient Records allows us to input those images directly into the patient's chart." For tests such as treadmills or stress echoes, the group uses a scanner to load the images. Within the chart, Coastal Cardiology has customized sections of Patient Records to store these cardiology-specific images. However, not all of their tests require scanning. For routine 12 lead EKGs, Coastal Cardiology employs a software based product (manufactured by Brentwood Medical) that provides acquisition, display, interpretation and storage using the PCs that are part of their Patient Records system. This eliminates the need for scanning, and the proprietary hardware required with traditional 12 lead devices. "Each PC has 12 lead capability" notes Dr. Famularo.