Pediatric Partnership: A Case Study of one Practice using PCC Partner Practice Management System with Office Practicum's EMR

Forest Hills Pediatric Associates, a six-provider practice in Grand Rapids, Michigan has used Partner since 2003 and recently implemented an EMR, choosing one of PCC's EMR partners, Office Practicum. We spoke with Practice Administrator Susan Wakefield, M.D. about their recent EMR implementation, and how it has worked for the practice in conjunction with Partner.

When did your practice go online with Office Practicum?

We started using it the second week of May, so we've been online for about four months.

How is it working for your practice?

We like Office Practicum. It's a powerful EMR and pretty intuitive to use. The support has been fairly responsive, but of course we've been so spoiled with PCC's support. The interface had a few bugs initially, but Office Practicum was able to work them out quickly. Once that happened, things have been fairly smooth. For something that is not an all-in-one product, it's been pretty seamless, and I'm happy with the way it's gone.

We're now back to our normal level of productivity and seeing about the same number of patients as before the EMR implementation. We implemented gradually, and did cut down our schedule for the first few weeks. Our income was down the first month, but now we're back to normal. It has still slowed us down a bit, but there are a number of other advantages, which I think will pay off. We don't just want to be hamsters running on the wheel, we want to provide better care to the patients we do have.

The doctors like it, especially in being able to retrieve information. We're still in the process of implementing a number of interfaces, such as a patient portal. As far as documentation goes, we're using a lot of templates that seem to make it pretty fast.

How did you make the choice to go with an integrated product rather than an all-in-one solution?

I feel like we're getting the best of both worlds. I love the reporting of PCC, and wasn't willing to give that up, but Office Practicum has a lot of cool functions. I looked at EMRs for three years or more. I looked at big companies and small companies, and I think Office Practicum's EMR has a lot of possibility. I'm still using PCC for reporting, and haven't fully learned Office Practicum's reports yet. As for support, PCC is on top of the pile. Office Practicum's support has not been not quite as good, but for things like the day to day work it has been fine.

You chose pediatric-specific software for both your practice management and your electronic health record needs. How has this made a difference for your practice?

It has definitely made a difference. PCC understands the business of pediatrics, and the attention to what is happening in the pediatric world is really wonderful. The annual PCC Users' Conference is great. I always learn something. PCC's Practice Management system also has a lot of crossover with clinical features, such as the diagnosis history, immunizations, and the search capability of diagnoses are all very well attuned to pediatrics.

Office Practicum's EMR also understands pediatrics. The immunization function has decision-support that tells you what imms the patient is due for and why. There are also templates for well visits that are based on Bright Futures, and it has ADHD, autism screenings, and asthma action plans embedded into the software–all pediatric-specific functions.

What did you hope to accomplish by implementing an EHR, and have you been able to do it?

I think we're on our way. I want to be able to do pediatric registries to follow patients with elevated BMI and asthma. I think patient care will be improved.

There are also changes in the way you do things in the office that make you more efficient. Once we have the lab interface, it will be smoother getting labs into the chart. We're also working on integrating the patient portal, which will allow patients (or parents) to do questionnaires before the visit, get patient records, and request an appointment. This will help with less wasted time in the office.

We've also changed the way we handle phone nurses. We usually get about 200 calls per day, some are triaged for scheduling appointments, but a lot of them are questions that get answered by nurses. Instead of having the hospital take phone calls after hours that don't know our patients very well, I've hired RNs to take phone calls from 5:00-11:00 p.m. on weekdays, and from 8:00 p.m.-8:00 a.m. on Saturday and Sunday. With the EMR they can use laptops to dial into patient charts at night. We can also access patient charts from the hospital to put in newborn information right then.

Having nurses on the phones has paid off, because a local insurer is paying for nurse call-backs that last five minutes or more. So we bill for those and have made about $1,500-$2,000 extra per month. Another thing I plan to get underway as we get more comfortable using the EMR is e-visits. Most of the insurers in Michigan now pay for electronic visits, so I'm hoping to use e-visits for things like chronic disease follow-ups.

Office Practicum will also be making some changes to their patient portal that will allow patients to request refills on their prescription that will come automatically to us. We're trying to do more electronically. I think this generation of of parents is more comfortable doing things this way.

It's definitely still a work in progress, and I have to have patience. One thing I would definitely say to anyone planning to go electronic is that you must pair down your schedule for the first six to eight weeks. I'm not sure if we can get back to the same volume level as before, but I'm hoping some of these changes will allow us to get paid better and provide better care to the patients we do have.