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A Reluctant Specialist Joins the EHR Ranks

by Jay Fleitman, MD, pulmonary specialist

After 30 years of using paper charts, I did not want to computerize my records. Don't get me wrong, I love computers, but most of my colleagues hated their EHRs. To make matters worse, the pricing I received from the bids I was getting from various systems’ vendors was prohibitive.

Truth be told, I didn’t care if I received the federal Meaningful Use money or suffered the penalties on my Medicare payments — in my mind, I wasn't moving to an EHR.

Then things changed. The Commonwealth of Massachusetts, where I practice, mandated the demonstration of meaningful use of an EHR to get a license to practice, starting in 2015. It soon became clear that I had to rethink this question of going electronic.

Not long after, I chose athenahealth’s EHR at the recommendation of a colleague. I was simply hoping that the experience of implementing and using an electronic health record was not going to be too unpleasant. And if nothing else, I figured at least the upfront cost and monthly charges for the use of the athenahealth system are far more reasonable than the other quotes I had gotten. 

I took the plunge.

As we went through implementation, my staff and I began to get a sense of the potential efficiency and flexibility that this cloud-based system provides. I had been hearing all along that an EHR would slow me down, but the time needed to document each visit and consultation through the EHR was pretty much a wash with paper charting. Yet, to my great surprise I found that overall my workday became about an hour and a half shorter with athenahealth.

Being a pulmonary specialist, my practice lives and dies by the communication we have with our referring providers. Over the years, before adopting an EHR, I had evolved to the point of dictating my consultations into my desktop computer using voice recognition software. But dictating two to three consultation notes from scratch at the end of each day meant an additional one to two hours at the office. Sending notes to referring physicians after follow up visits was impossible if I was to ever see my family.

Now, my EHR allows me to generate consultation letters directly off the templates I use to do the charting in the first place. As referring physicians and providers are really most interested in the Assessment and Plan parts of the consultation, at the end of each day I now only have to review and elaborate on those parts of my notes. With a simple click at the end of each follow-up visit, I can automatically send a templated version of my note directly to the referring provider. My ability to communicate with my referral base is far more efficient and extensive these days. Before long, these improvements helped shorten my workday by an average of 90 minutes. I now get home at a much more reasonable time.

While the workflow improvements in the office have been fantastic, the best part of adopting a cloud-based EHR system became clear outside of the exam room: I can log on at home and review lab results, renew prescriptions, respond to staff inquiries, and answer patient emails through the patient portal. Previously, unless I wanted to lug large piles of charts home with me, I was a slave to my office. Now I can do my work in far greater comfort – my couch or home office – and when it is more convenient – after dinner or during breakfast, perhaps. I can even dictate messages directly to my staff through the clinical dashboard while I am still in my pajamas. 

Who would have guessed? I was dragged kicking and screaming into converting to an EMR, and I expected only pain and suffering. Instead, I find myself at home with the ability to tailor my work more to my lifestyle. I can do my work from home around a leisurely breakfast. I just have to remember to take off the headset when I'm having my morning coffee, or I will ruin the mic (not that I’ve done that…).


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