There's no question that EMR adoption is a significant undertaking--financially, operationally and culturally--for physicians and practices. But what if, before becoming embroiled in the process, you could magically see how going electronic would transform your practice one year later?

Unfortunately, we at FiercePracticeManagement have yet to invent a working crystal ball--but we can bring you the next best thing. We recently spoke with Randy A. Fink, MD, FACOG, medical director of the Miami Center of Excellence for Obstetrics & Gynecology, about his experience implementing Sage's Intergy EHR. As the first practice in South Florida's VitalMD network to roll out the technology, Fink describes the challenges, benefits and lessons brought in his group's EHR conversion thus far.

FPM: What was the biggest reason your practice chose, one year ago, to adopt an EHR?

RF: We knew that adopting EHR was going to be something we would have to do eventually. In our case, we were moving to a new office space, so the timing was ideal to be able to install an infrastructure that would support it. We were also overwhelmed with patient charts, and it was really time to get rid of the paper. We could often spend hours looking for a chart for a patient. We have a large office with a large office staff, and there are a lot of nooks and crannies where a chart could hide. And quite frankly we were tired of it. We wanted a more efficient way to be able to process our patient information, a more efficient way to do our billing, and we were just plain old tired of seeing the paper.

FPM: Was attaining EHR incentive payments from the government an important factor in your decision to adopt an EHR? If so, what is your practice doing to ensure it achieves meaningful use?

RF: [The incentive] was sort of icing on a cake, but it was on a cake we would have otherwise chosen to acquire. With technology being what it is and information processing being what it is, we just needed to be more efficient. So irrespective of meaningful use, we would have made the choice to implement an EHR. As far as compliance, we're just really scratching the surface as to what that means and to how--if at all--we're able to benefit from those incentive payments. We've sought the advice of a professional consultant to see whether and how we will benefit from it.

FPM: What has been the No. 1 benefit you've achieved from your EHR thus far?

RF: No. 1, it's certainly made us more efficient. Instead of working harder during the day, we're working smarter. And I know that if I have my office working smarter, I sleep better at night not only knowing I did the right thing for patients, but that our bottom line is not going to suffer. Any investment that we've made for our EMR has paid off--and that's been a very nice thing to know.

No. 2, it's improved the way we can bill because our documenting is that much more thorough. Because compliance with E/M coding guidelines is implicit in the system, we were able to capture higher-coded visits we were undercoding before. To be specific, visits that were 99213s, for example, are now 99214s; and many of the level-four visits are now 99215s, whereas previously we might not have known to go there.

FPM: What has been the biggest surprise to you during the implementation?

RF: The piece that was the biggest surprise to me was the way it changed our communication. I had heard from patients about doctors who were always looking at computer and never made eye contact, and wondered how that could be--until I had it in my exam room. The reason this occurs is that you feel very compelled to document things correctly and to do it right the first time. It's easy to forget that you're there seeing a person who has needs, has emotions, and is not just the right documentation to justify an E/M code. It takes time, but once you're used to it, you understand how to integrate keyboard and monitor or notebook computer into your previous comfortable level of communication.

FPM: Did you experience an initial slowdown in productivity?

RF: Absolutely. Essentially for our first four weeks--probably longer than needed for most of us--we cut our schedule in half. The flipside of that is we were able to make up a great deal of that in terms of our improved billing. In addition to no longer undercoding in some instances, we're able to capture more problem visits added into our annual or well-woman visits that we were losing before. So we really made up for that loss in productivity strictly from an income perspective.

FPM: What's been the biggest lesson?

RF: That I should've gone to law school. Kidding aside, our EMR implementation has reinforced the need for patience. I think we have been very successful with our EMR, and really think it is appropriate for most practices, and I would venture to say for any practice. It's something anybody can do, anybody can learn and I think that there is a very workable EHR solution for any type of practice.

That said, as a physician, when I give an order or say I need something, I need it now. And you need it to work right immediately. So it has taken a little patience to know we're heading in the right direction, but that the pace of that movement might not be the one I would have chosen. It's hard sometimes to get IT people to always agree as to what a problem is. It's hard to work with clinicians that aren't as comfortable with the computer and expect them to adopt and adapt as readily as some others. Though this may sound like a negative, it's with the understanding that there is a measurable benefit from having an EMR. If you keep your eyes on the prize, than those little hurdles are just that--obstacles to leap over.

FPM: What's next?

RF: Our next goals are being able to fully utilize our EMR system from outlying areas that we serve and being to access it from labor and delivery or from my iPhone. These are all things of evolution for us.

Right now, because we can't access our EMR remotely, it means if a prenatal record is not there at labor and delivery or we need something from a patient's prenatal lab records, somebody has to call the office and the prenatal has to be faxed over. So that is certainly in the area where efficiency can be improved. But at least we don't have to wait on hold for office staff to search for the chart like in the old days. We're going in the right direction.

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