Practice Fusion Blog

Instant Physician Networks – a new term for EMR 2.0

Practice Fusion, by means of its ability to rapidly deploy practices and get them charting right away (“Live in Five”), has the ability to sign up large groups of physicians very quickly. Recently, several large groups have signed up with Practice Fusion, and have become what can be described as an Instant Physician Network.

 

What is an Instant Physician Network? It is a collection of physicians linked as a community in some way – a medical group, an IPA, etc – which are all on the same Practice Fusion platform. As such, they instantly have access to each other, and can share clinical and other information with each other seamlessly. In addition, as a community they may have data reporting that is useful community-wide, or may be approached through targeted ads in an appropriate way.

 

This is a novel concept, since traditional EMRs have required considerable effort, expense and disruption in order to install, and can take days-to-weeks to launch in each-and-every practice site. And, assuming that widespread installation of compatible EMRs can be accomplished in medical communities with traditional “1.0” EMRs, clinical data sharing is still problematic, as clinical data remains fragmented among the local practices in “data silos” – adding layers to facilitate sharing of data is a whole additional burden that stands in the way of “one patient-one chart.” By contrast, the Practice Fusion model is built on a hosted, shared platform, with the intent of clinical data sharing being the default. No extra effort is needed.

 

Deploying hundreds, or even thousands, of new practices in a day was hardly conceivable in an old “EMR 1.0” setting – however, the unique web-based, fully-hosted design of Practice Fusion allows this to take place quite easily. Most importantly, since the hosted, web-based design of Practice Fusion (EMR 2.0) is built for data to be shared between practices using the system, on-line communities can spring up “instantly.”

 

As Practice Fusion continues to evolve, and the new frontier of Instant Physician Networks comes into play, we will see new potential and new benefits in the months and years to come.

 

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

Strategies for Scanning Old chart Documents into Your EMR

One of the strategic issues facing medical practices that are moving from paper charts into an EMR is the question of what to do about old paper chart information. Should there be an exhaustive attempt to scan all the old charts and import them into the EMR? Some practices have elected to do this. Or, should one be more selective, and if so, then what sort of selectivity should be applied?

 

In practical application, the older the data in the chart becomes, the less useful it is for day-to-day medical decision-making. An exhaustive scanning and importing of old chart information is probably wasteful of time and resources, and may delay implementation of the EMR into your practice. Yet there is some information that in indeed useful – items like old EKGs (for comparison to future ones), old mammography reports, or colon cancer screening reports (or any other HEDIS data point that can be the basis of good medical practice as well as Pay For Performance reporting) – these sorts of selected items may well be good to have in the EMR at the outset.

 

Some practices have hired a medical abstractor clerical person to go through all the old charts and pull out the selectively-desired items for mass scanning. That can be daunting and expensive. Another approach (one which I believe is more practical) is to pull the paper chart when seeing the patient (just like always), and use it alongside the EMR. Then the desired “old” pages can be pulled from the paper chart as-you-go, set aside for scanning and importing into the EMR, and then the paper chart can be retired to off-site storage. Over time, the number of patient visits for which there is still an “un-retired” paper chart diminishes.

 

One can always retrieve an old paper chart from offsite storage for looking through detailed entries (e.g. if your records are subpoenaed several years after-the-fact), but over time the frequency with which this comes up becomes vanishingly small. After about a year, it is likely that you will seldom need or see your old paper charts.

 

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

One of the strategic issues facing medical practices that are moving from paper charts into an EMR is the question of what to do about old paper chart information. Should there be an exhaustive attempt to scan all the old charts and import them into the EMR? Some practices have elected to do this. Or, should one be more selective, and if so, then what sort of selectivity should be applied?

 

In practical application, the older the data in the chart becomes, the less useful it is for day-to-day medical decision-making. An exhaustive scanning and importing of old chart information is probably wasteful of time and resources, and may delay implementation of the EMR into your practice. Yet there is some information that in indeed useful – items like old EKGs (for comparison to future ones), old mammography reports, or colon cancer screening reports (or any other HEDIS data point that can be the basis of good medical practice as well as Pay For Performance reporting) – these sorts of selected items may well be good to have in the EMR at the outset.

 

Some practices have hired a medical abstractor clerical person to go through all the old charts and pull out the selectively-desired items for mass scanning. That can be daunting and expensive. Another approach (one which I believe is more practical) is to pull the paper chart when seeing the patient (just like always), and use it alongside the EMR. Then the desired “old” pages can be pulled from the paper chart as-you-go, set aside for scanning and importing into the EMR, and then the paper chart can be retired to off-site storage. Over time, the number of patient visits for which there is still an “un-retired” paper chart diminishes.

 

One can always retrieve an old paper chart from offsite storage for looking through detailed entries (e.g. if your records are subpoenaed several years after-the-fact), but over time the frequency with which this comes up becomes vanishingly small. After about a year, it is likely that you will seldom need or see your old paper charts.

 

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

Stepping Stones to EMR adoption

You have your new EMR up and running… now what? How do you get from a paper-based office to an e-office? It can seem like a daunting task – like trying to get from one bank of a river to the other, and the river seems too wide to cross in one giant leap (even if you are enthusiastic). You need stepping stones to get from here to there.

One of the challenges of EMR implementation is that every workflow in a physician’s office that touches a patient’s chart – in other words, everything – needs to be re-thought when that chart is no longer on paper. And a surprising number of activities touch a patient’s chart – not only chart note creation, but also in-house messaging, prescription refill management, lab test review, importing information from the “outside world” into the chart, etc.

It is probably best, while getting used to an EMR system, to run in tandem for a while, and keep the old paper charts alongside the electronic ones. That transitional phase might be referred to as a “computer-assisted paper chart.” You can start simply by using the EMR to create chart notes, then print them out for placement in the paper chart. You would still use the paper chart as a way of tracking the patient through the office – putting the chart on the exam room door, on in a desktop stack to know who is to be seen next. Subsequently, you could add in-house messaging, so that when staff fields phone calls from or about patients, the Messaging module of the EMR would be used (instead of “sticky paper” notes). Front office staff can simultaneously use the Scheduling module of the EMR for making appointments and checking patients in. Later, once you feel comfortable with the “live” use of the EMR, you could use the EMR directly to know where the patient to be seen is.

By carrying out a step-by-step implementation plan (it will require some strategic planning at first), you could postpone needing to use wireless laptop or notebook computers (instead of paper charts) to carry around into patient exam rooms – instead you could have a desktop to do charting, and carry the paper chart with you. Later, you could make the transition to use wireless portable machines instead of the paper chart as part of your daily workflow. There are multiple paths across the stepping stones from the “paper bank” to the “e-bank” of the river, and the modular design of Practice Fusion will be flexible enough to allow you a pathway that makes sense for you.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

You have your new EMR up and running… now what? How do you get from a paper-based office to an e-office? It can seem like a daunting task – like trying to get from one bank of a river to the other, and the river seems too wide to cross in one giant leap (even if you are enthusiastic). You need stepping stones to get from here to there.

One of the challenges of EMR implementation is that every workflow in a physician’s office that touches a patient’s chart – in other words, everything – needs to be re-thought when that chart is no longer on paper. And a surprising number of activities touch a patient’s chart – not only chart note creation, but also in-house messaging, prescription refill management, lab test review, importing information from the “outside world” into the chart, etc.

It is probably best, while getting used to an EMR system, to run in tandem for a while, and keep the old paper charts alongside the electronic ones. That transitional phase might be referred to as a “computer-assisted paper chart.” You can start simply by using the EMR to create chart notes, then print them out for placement in the paper chart. You would still use the paper chart as a way of tracking the patient through the office – putting the chart on the exam room door, on in a desktop stack to know who is to be seen next. Subsequently, you could add in-house messaging, so that when staff fields phone calls from or about patients, the Messaging module of the EMR would be used (instead of “sticky paper” notes). Front office staff can simultaneously use the Scheduling module of the EMR for making appointments and checking patients in. Later, once you feel comfortable with the “live” use of the EMR, you could use the EMR directly to know where the patient to be seen is.

By carrying out a step-by-step implementation plan (it will require some strategic planning at first), you could postpone needing to use wireless laptop or notebook computers (instead of paper charts) to carry around into patient exam rooms – instead you could have a desktop to do charting, and carry the paper chart with you. Later, you could make the transition to use wireless portable machines instead of the paper chart as part of your daily workflow. There are multiple paths across the stepping stones from the “paper bank” to the “e-bank” of the river, and the modular design of Practice Fusion will be flexible enough to allow you a pathway that makes sense for you.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.