Electronic Medical Records – A Success Story!

By Kristie Thorson, MAFP Communications Coordinator
From March/April 2002 Minnesota Family Physician

“It’s complicated; it slows you down; it’s aggravating!” These are all phrases Barry Bershow, M.D., used to describe his clinic’s transition to an electronic medical records system. Despite the frustration, he and the five other physicians who own and operate Burnsville Family Physicians, PA, decided they were going to make it work – and they did!

It started in March of 1999 as a pilot project with Fairview Physician Associates. The Burnsville clinic would make the switch and see how it went before other clinics joined on. After evaluating the system thoroughly, the doctors decided it was definitely worthwhile. The Burnsville clinic has been running paperless for almost three years!

The following is an interview with Dr. Bershow.

MFP: Why make the switch to an electronic system?

Bershow: The net results for us have been physician satisfaction, patient satisfaction and economic benefits. It was a tough decision for us to go ahead with it. We had no shield from economic woes. If the system caused us to lose money, it would be coming right out of our pockets. But now, we are doing better economically than we were before. We are very excited about what such a system can do. We want others to be excited about it, too.

MFP: More specifically, discuss what it can do for a physician/clinic?

Bershow: It improves our quality of care. With our electronic medical records system, the computer initiates best care practices. The computer does all the behind the scenes work, such as looking up labs and checking to see if other tests are done. For example, it can track patients who need their liver function tested on a regular basis. If a patient comes into the office for something else, the computer will notify us that the patient needs that particular test also. There is no added work for the doctor to go back and check everything.

MFP: What about patient safety?

Bershow: That’s a big benefit. There is high-end drug interaction software working within the system. If you put in a prescription for a patient, it will check how that interacts with any other drugs the patient is on. If there’s a problem, a warning will pop up on the screen. For example, I had a patient come in and I prescribed something. The computer told me the drug I was prescribing would have a negative interaction with another drug the person was taking and could cause seizures. Of course I decided not to prescribe that particular drug. Quite honestly, something like that might not have been caught and the patient would have walked out of here with an increased potential for seizure. Another example, if a patient is allergic to a medication, it won’t let you prescribe it at all. The software can also calculate correct pediatric doses.

MFP: What do your patients think about the system? Do they even notice?

Bershow: Oh, they notice. At first some people were worried that patients would be unhappy that their doctor was sitting in the office with them and working on a computer. That was not the case. The computer is actually a great education tool. We have flat screens and we rotate them so both the doctor and patient can see. I use the computer to track trends and display diagrams that the patient can look it. The patient can see his weight or blood pressure chart, instead of just trying to visualize what I’m saying. I call it “sharing care.” Plus, the system has more than 7,000 handouts on different diseases, drugs, etc. Doctors can pull up diagrams and handouts in a matter of seconds. They can be printed out in either English or Spanish. A patient can leave the office with information on a particular disease, a handout on their prescription guidelines and written information about their follow-up appointment.

MFP: How much actual training did this system require?

Bershow: Because the system is so complex, it was honestly very difficult to learn. There were hundreds of areas to tackle. It did take about 20 hours of formal education. We would stay late on a Monday and Tuesday night to learn one particular part of the system and then that part would be turned on later in the week for actual use. This process was repeated until we had learned the entire system. It was painful at first and it required long hours. It took me about three months to be as efficient with this system as I was with the old one. Now my last patient leaves at 5:00 p.m. and I am out the door by 5:10 p.m. There are no prescriptions to write, nothing in my inbox, no dictation to do and nothing to take home with me.

MFP: So you’re using voice transcription software also?

Bershow: We could use it, but we don’t. I don’t think we need it. We just keyboard our notes in. All you have to do is hit afew keystrokes and menus will pop up, etc. You really don’t have to type all that much. You can enter data while you’re in the room with the patient or taking calls.

MFP: What about the cost?

Bershow: The cost would be different for everyone. We went through a company called EPIC which makes a variety of different products. We have an integrated package through them which also does our billing. Our system is one of the more expensive ones, but labor savings alone exceeds the software cost. It has definitely paid for itself in two and a half years. We were able to do away with four full-time equivalencies. We didn’t lay off anyone, we just didn’t rehire when people left.

MFP: Are there even more possibilities for your system?

Bershow: There are. We hope that soon, patients may be able to use computers in the lobby to do things like book and cancel their own appointments, pull up labs, or print their child’s immunization report. This will help to decrease our front desk needs.

MFP: Do you have any regrets about switching over to an electronic medical records system?

Bershow: No one here can imagine practicing without it. We did meet a little resistance from a few staff people as they learned the new work flows, but now everyone sees the value in it. One of our doctors came out of his office, ripped a prescription off of the printer and went back in with big smile on his face saying “If this were any more fun, it would be illegal.”