By Cindy Atoji

July 15, 2008 | It can take years to roll out a fully functional EHR system, yet The George Washington University Medical Faculty Associates (MFA) did it in 30 days and continues to reap “stunning” ROI and “dramatic efficiencies,” according to Stephen Badger, CEO of MFA, one of the largest multi-specialty physician practices in Washington D.C. Although the work on the EHR continues, particularly in the areas of data capture and specialty templates, Badger says that the lessons that his organization learned are valuable practices and can speed EHR rollouts in other ambulatory settings. Digital HealthCare & Productivity spoke with Badger about how EMRs can be implemented rapidly and efficiently, even in very large practices.

DHP: A typical EMR implementation takes between 18 and 36 months. Why did you decide to try to do this in 30 days?
BADGER: We set an aggressive timeframe, believing that speed in implementation can lead to more rapid physician adoption, as well as faster safety and quality benefits for patients, and more substantial recognition of a return on investment for our organization. MFA, like many physician practices, was getting bogged down by inefficient paper-based methods for storing patient charts, tracking lab results, prescribing medicines, billing insurers, and other labor-intensive and time-consuming record keeping methods. We wanted to adopt a more efficient electronic solution in an expedient matter.

DHP: Given the size of your department of medicine—99 physicians and 130 residents and interns, plus support staff—how did you accomplish this?
BADGER: The rollout plan was lead by a team of physicians, administrators, and information technology experts. We identified stakeholders who helped us define the project scope, plan, and design, and then laid out which part of the electronic health record was going to be done sequentially, pushing applications out in a progressive fashion so we would be paperless by the target date. The team met on daily basis for entire the month to make adjustments and respond to issues.

The basis of a good EHR project is to map and analyze paper-based work processes, and then convert these workflows into electronic processes that can be facilitated by EHRs. We found numerous paper protocols that could benefit from standardization, such as the medication renewal process. We literally mapped out every task on a whiteboard then analyzed how it could be improved upon electronically.

DHP: What were some early implementation strategies?
BADGER: Initially, when we decided to purchase an EHR, we evaluated six of the leading market solutions, and based our decision on the technology’s ability to meet our practice’s needs. We wanted a product that would integrate seamlessly with our existing core practice management system, IDX Flowcast. It also had to support a phased implementation, allowing us to roll out one mode of functionality at a time, rather than a “big bang approach.” With this criteria in mind, we chose Allscripts’ TouchWorks EHR, which has integrated clinical documentation and messaging, decision support, results reporting, order entry, task management, and administrative processes.

We acquired and tested different pieces of the software, with a small group of physicians, so we could know and understand the product in enough detail to be able to do the rapid rollout. We didn’t go live with it first; we used it in a test environment and on a small limited basis, and it wasn’t a unified electronic health record at that time. There were interfaces in place and we tested to make sure the data was coming in correctly, so we knew we didn’t have problems in sending data into the system and having it misfiled.

DHP: What pushback did you receive, and how did you deal with it?
BADGER: It is never easy to convince seasoned health care professionals to change the way they’re used to doing their jobs. Our training strategy focused on one or two EHR modules a week. The first week focused on Tasking and Results, two components that allowed doctors to immediately see how the EHR could make their lives easier, although we were careful not to call the EHR a panacea.

Instead of directing or mandating how the data was going to get into the system, we also allowed our physicians to have different approaches to getting the data into the EHR. This was something that allowed the physicians to embrace it because we were not turning their world upside down, just giving them new tools to be able to do a better job because the data would be at their fingertips.

DHP: What sort of ROI are you seeing?
BADGER: Instead of decentralized paper processes, we now have more highly efficient, centralized, and automated business processes. Shortly after the initial rollout, which occurred three years ago, we had a conservative ROI analysis done, which revealed a first-year savings in daily paper chart pulls of $81,551 (taking patient charts out of storage and then putting them back in again). When you factor in RN time devoted to chart responsibilities, this number jumps to $335,900 saved in staffing expenses.

There are also savings on space, paper, storage, people, rent, and other resources. One of the things we did was free up 5,100 square feet of space for clinical purposes instead of [using it] employing people to keep up with the paper. And the scanning system that integrates with both the practice management system and the EHR and our HIPAA EDI tool kit eliminates an enormous amount of paper from the environment.
 
We have no paper records or any paper EOBs (Explanations of Benefit). All the EOBS are either electronically downloaded or scanned rather than recycled. So between electronic health records, EOBs, referral forms, prescription form, we have over 26 million pages stored electronically.

In other areas, the EHR has eliminated improper coding of reimbursements, because of the EHR’s built-in documentation templates. Lab results, which can take days or weeks to arrive, and sometimes went to the wrong provider, now go directly to the ordering physician via the lab; the prescription process has also been streamlined. Physicians can also get real-time reminders and task lists electronically.
 
DHP: How are you continuing to build on this today?
BADGER: We continue to look at different ways of getting data into the system, and continue to make refinements. Some of the physicians are developing additional templates so we can make sure patients go through a standardized process with certain disease-related issues. I view this as more of a journey than a destination. The EHR has become part of fabric of organization and reduced our costs and enhanced quality of care.