# Presentation: 731094

## 
James R. Morrow, M.D. 
North Fulton Family Medicine
Cumming, Georgia

**James R. Morrow, M.D.**** **
**North Fulton Family Medicine**
**Cumming, Georgia**

**Toward Quality Care**

## “Skate to where the puck is going, not where it is.

**Wayne Gretsky**

## Slide 3

## Why Use Electronic Records?

**CEO, Medical Record Institute**

**“****The biggest killer in healthcare is the pen. It can be misread, misplaced, and not shared.”**

**Why Use Electronic Records?**

## North Fulton Family Medicine

- 2004

- 1998

- Offices
- Physicians
- Physician’s Assistants
- Registered Nurses
- Administrator
- Business Manager
- Office Managers
- Daily Encounters

- 2
- 4
- 0
- 1
- 0
- 0
- 1
- 100

- 3
- 8
- 8
- 4
- 1
- 1
- 3
- 300+

## NFFM Staffing

- 2004

- 1998

- FTEs

- per provider

## Why Did We Succeed?

**A strong physician desire to initiate change**
**A need to bring costs under control**
**A good implementation team**
**An implementation specialist who cared about our needs**
**A company who puts service above everything else**

## Metcalf’s Law

***Robert Metcalfe***Inventor of the Ethernet

***“******The value of a network increases as the square of the number of users on it.”***

## Why did we really succeed?

**R**

**O**

**I**

**eturn**

**n**

**nvestment**

## Our ROI

**Based on 100 patients per day**
**Chart handling: 100 charts managed/day; 625 mins @$11/hr = $29,791/yr**
**New chart formation: 19.6/day @ 10 mins per chart; 196 mins @ $11/hr = $9,342/yr**

## Our ROI

**Based on 100 patients per day**
**Chart searches: 330 mins/day @ $11/hr = $16,456/yr**
**Transcription: transcribing, filing, managing: ~ 20 lines per note @ $0.10/line = $110,000/yr**

## Lab Results: Logging, delivering, attaching results @ 45 draws/day= 315 min @ $12/hr = $16,380/yr
Referral Letters: Dictation and transcription = $32,640/yr
Chart Supplies: encounter forms, progress notes, lab sheets, history forms, problem lists = $24,480/yr

**Referral Letters: Dictation and transcription = $32,640/yr**
**Chart Supplies: encounter forms, progress notes, lab sheets, history forms, problem lists = $24,480/yr**

**Our ROI**

## Our ROI

**Represents a savings of 44 hours per day or 11,440 billable staff hours per year**
**Total saved (year) = $239,089 (at 100 patients per day)**
**At 300+ patients per day the  savings = REAL MONEY**

## The Bottom LineCost Per Patient Visit

- Paper

- EHR

- $112.	47

- $79.32

- Savings

- $33.15/visit

- $4309.00/day

- $2,625,480/year

- 130 per day, 22 days, 12 months

## Access Access Access

**Allows patients to **
**Message us securely, quickly**
**View lab results**
**View medication lists**
**View problem lists**
**Request refills, referrals, appointments**
**Manage their care better**

## Slide 16

## Slide 17

## Slide 18

## Privacy of the PHI

**Data is secured**
**Three levels of passwords necessary to access the data**
**Passwords change regularly**
**Never a pre-determined password**
**Firewall/Antivirus/Backup**

## What Does AllThis HIT Do For Physicians and Our Patients?

## Outcomes Are The Real Rewards

**We can now affect and track quality of care at an outcomes level**
**Track HgbA1c’s, LFT’s, PT’s, PSA’s, cholesterol, blood pressure levels**
**Monitor compliance rates of  routine screenings (colonoscopy,  mammography, bone density, exercise stress testing, etc)**

## Visual Reinforcement

**Visual Reinforcement**

## External Connectivity

**Now we receive reports**
**securely**
**electronically**
**legibly, and**
**much more quickly from area hospitals.**

**Notes:**
We can keep a scorecard of how we are doing. When a new provider comes on board with us we can audit their care patterns easily and efficiently, making them better providers in the near future.

## Connected

**Notes:**
We can keep a scorecard of how we are doing. When a new provider comes on board with us we can audit their care patterns easily and efficiently, making them better providers in the near future.

## Tracking Tests and Procedures

**Ability to monitor tests**
**Search for labs not yet resulted or  reviewed**
**Search for procedures not yet resulted or reviewed**

**Notes:**
Tracking unresulted or unreviewed lab and procedure results has changed our outcomes as well. The ability to know that all ordered labs and procedures have been resulted is a tremendous boom to the practice both medically and legally. It gives a real sense of satisfaction and calm to know that the tests you are ordering for your patients are actually being done, and the patient is notified of the result.

## The Future is Here...

**P.R.A.C.T.I.C.E.**

- ®

**The Future is Here...**

**Notes:**
Tracking referrals has been a real challenge. Probably as great a challenge as any I have seen in medicine. We can track this electronically now better than ever. In an environment where we can actually know if a patient has followed through with a referral, we are able to better help the patient get the care they need.

## P.R.A.C.T.I.C.E.

- New software agent connects physicians so that patient outcomes are more manageable/predictable

**P.R.A.C.T.I.C.E.**

**Notes:**
An electronic means of tracking these referrals is the best, eliminating the need to manually attempt to so this. A task that is essentially hopeless in the paper based office.

## Slide 28

## Slide 29

## Slide 30

**Notes:**
An electronic means of tracking these referrals is the best, eliminating the need to manually attempt to so this. A task that is essentially hopeless in the paper based office.

## What Can the Government Do to Assist in this Paradigm Shift?

## The Government Can...

**Support assets like the Quality Improvement Organizations (QIOs)  in the 8th Scope of Work.**
**Provide financial incentives to practices to implement EHRs.**
**Implement or widen Pay for Performance incentives.**

## The QIOs Can Assist In...

**Readiness Assessment**
**Workflow & Care Process Redesign**
**Creating an Implementation Team**
**Planning for Implementation**
**Financial/Cost analysis **
**Analysis of hardware/software needs**
**Quality Improvement Assistance**
**Help establish infrastructure for P4P**
**Support the rapid establishment of standards **

**Notes:**
Helping more physicians adopt HIT, undertake Quality Improvement projects and be capable of reporting data will help build the infrastructure needed for P4P.

## Incentives & P4P

**Right now, Quality doesn’t pay**
**Most HIT benefits accrue to others, not physicians**
**P4P should begin with Pay for Use**
**Give physicians access to assistance to help them implement and use HIT well**
**Expand current P4P projects as we learn what works**

**Notes:**
-Studies indicate that 89% of benefits of HIT accrue to others, like payors.
-We should reward physicians who provide quality care;
-HIT is one tool to improve quality, but isn’t guaranteed by itself to improve quality or efficiency.
-Can increase chances of improved quality and efficiency by giving physicians access to assistance, such QIOs are doing now
-Expand P4P once we see what works, doesn’t work and what physicians need by way of support to improve their care and be rewarded for it.

## Establishing Standards

**EHR Standards re: functionality/solutions (CCHIT)**
**Connectivity**
**Language (HL7, LOINC, SNOMED, CPT, ICD-9)**

**Notes:**
-Studies indicate that 89% of benefits of HIT accrue to others, like payors.
-We should reward physicians who provide quality care;
-HIT is one tool to improve quality, but isn’t guaranteed by itself to improve quality or efficiency.
-Can increase chances of improved quality and efficiency by giving physicians access to assistance, such QIOs are doing now
-Expand P4P once we see what works, doesn’t work and what physicians need by way of support to improve their care and be rewarded for it.

## Conclusion

**Success is within reach**
**The evolution of IT and healthcare is upon us now**
**The return on investment can be measured in real dollars**
**The ultimate ROI is quality improvement, job satisfaction, a sense of accomplishment, and success in today’s changing world**

## Conclusion

**We can do better re: documentation**
**We can do better re: test and procedure follow-up/follow-through**
**We can prevent bad outcomes as well as missed opportunities by monitoring referral and test compliance**

## James R. Morrow, M.D. 

**James R. Morrow, M.D.**** **
**North Fulton Family Medicine**
**Cumming, Georgia**
**drmorrow@nffm.md**

**Toward Quality Care**