PAC Uses Decreased Visit Volume as an Advantage for Gradual EHR Implementation

Recently on PedSource, we posted an article about how PCC practices fared through  obstacles of last year, including the economic downturn and advent of the H1N1 flu strain. While we found variance from practice to practice and region to region, overall we found that most practices did well financially, though many had to work harder than in previous years (scheduling more sick visits in lieu of well child appointments or to accommodate H1N1 related appointments).

One PCC practice, Pediatric and Adolescent Care of Tulsa (PAC), Oklahoma, took a different tactic for surviving the economic downturn. The practice has been planning to adopt an Electronic Health Record for several years, but when PAC partners saw the writing on the wall about the downward trending economy, rather than tightening spending as was the initial reaction for many other practices, PAC felt this was the perfect time to invest, namely with the adoption of their long-awaited EHR. The practice decided on Office Practicum after first meeting the vendor at PCC's annual Users' Conference the previous year.

"Everyone knows productivity will be down during the EHR training and implementation process," said Dr. Hendricks, a managing provider at the practice. "We felt it was a bigger risk not being available when patients needed a visit than investing in the future and 'retooling' in the slow time. We researched and installed hardware last winter, started training in April, and went live with our EHR in May."

Dr. Hendricks said the practice purposely didn't send out reminders for well visits over the summer, counting on a more open schedule to give their staff time to adjust to the EHR. "We used the lower patient visit volume to give us the extra time as we become skilled with the new EHR and deal with unanticipated bugs."

In choosing their EHR, he said all of the partners agreed the practice was not going to give up PCC. “One of the main reasons we picked Office Practicum was the integration assurance from both parties. Support went the extra mile to get all the information over to Office Practicum, answer our questions, and occasionally do some hand-holding.”

Rather than see the decrease in visits as a negative, the practice used the lower visit volume to their advantage in order to adopt a phased EHR implementation process. Dr. Hendricks estimates that the practice is now about 80 percent integrated to their EHR, charting all new visits in the software and slowly working on scanning in the old charts.

He said they hope to be fully integrated within the next year, adding that it takes "an awful lot of time to load the legacy stuff." Instead, the practice has been taking patients' important past medical history and manually entering things such as the problem list and allergies. "The next phase is to scan in everything that hasn't been entered manually."

While the practice used the lower demand for appointments to lessen the stress level during their gradual EHR implementation, they did not anticipate the busy fall months due to the H1N1 epidemic. Although Dr. Hendricks said the Tulsa area wasn't hit too hard and didn't affect going forward with the implementation, "We were stressed with the number of phone calls and the number of people wanting appointments."

The practice dealt with the increased volume by working increased hours when necessary, and Dr. Hendricks said they learned some skills that will help them out this winter in preparing for the traditional flu season. With the economic downturn, the overall impact of turning down patients due to our phased EHR implementation was minimized," he said, adding, "I think we're in really good shape for winter.”

The practice plans to send the usual reminders for well child visits in March to those families who need a memory jog for preventive care, and by then, their physical exam information will be fully integrated with the school and camp forms.

"It isn't easy to invest in an EHR when times may be tough. I think we have taken the hard times and used them to the best advantage for our patients and our practice."