Transition may be challenging but moving forward is imperative

According to Thomas J. Grogan, MD, there’s more to running a successful orthopaedic practice than following sound business principles and providing cost-effective care. Using technology to modernize the practice is another key piece of the puzzle.

Transitioning to EMRs
Every day, said Dr. Grogan, ortho-paedists interact with patients, other physicians, laboratories, surgery centers, hospitals, and many other sources of information. Systems that help coordinate care among all of these entities, he said, must be easy, adaptable, affordable, and universally applicable.

“An effective system of data management,” noted Dr. Grogan, “makes a practice more efficient, and therefore increases revenue.” Although some systems were expensive and bulky when first introduced, he said, they are becoming cheaper, smaller, and easier to use.

He noted that one method of data management—electronic medical records (EMRs)—can benefit patients by helping facilitate coordination of care. EMRs commonly include integrated practice management (PM) billing software, fully functional word processing with spell check, speech recognition, e-prescribing, optical mark recognition for outside practice reports, as well as an integrated picture archiving and communication system (PACS).

“When there’s a data-based patient record, there are fewer mistakes, fewer problems, and fewer complications,” said Dr. Grogan.

He noted that the Center for Studying Health System Change issued a report in December 2009 that studied how 26 practices with 52 physicians used their EMRs.

“Their conclusions were that EMRs do facilitate in-office care coordination,” he said, adding that “the current fee-for-service environment encourages using EMRs to capture all billable events.”

Some issues do exist with EMRs, acknowledged Dr. Grogan.

“Some clinicians believe that EMRs are incapable of capturing the decision-making processes for out-of-office care coordination,” he said. “In other words, they view EMRs simply as data collection tools, not something that’s going to help them interact and provide better care,” he explained.

A problem that Dr. Grogan describes as “information overload” can also occur. In large EMR systems that contain information on every medication a patient is or was taking during a given period, he said, it can be difficult to “glean useful information.”

Using PACS
A PACS increases the speed in which radiographic images can be obtained, transported, and used. Incorporating archived images into a PACS should be an easy process, said Dr. Grogan.

“[The system] needs to be able to connect to outside points of care and be accessible via the Internet anywhere,” he said. “Any EMR system should have a portal through your PACS.”

Dr. Grogan recommends storing the data on a remote server.

“It doesn’t cost a lot and you don’t have to worry about losing the data in your office,” he said.

To make a PACS cost-effective, he said, it’s important to upload information using a low-bandwidth data line. Dr. Grogan, a solo practitioner in a group with five other solo practitioners, noted that the other physicians were only interested in pursuing a PACS if it cost less than they were spending on traditional radiographs.

“We were able to do that because the cost of film and processing is actually fairly high—approximately $1.52 per radiograph,” he said.

Using connectivity tools
Many resources exist to help increase communication among orthopaedists, patients, and referring physicians. The goal of using tools such as interactive Web sites, EMRs, PACS, personal digital assistants, and social media, including Twitter and Facebook, said Dr. Grogan, is to “improve connectivity to improve outcomes, decrease costs, and improve profitability.”

He noted that interactive Web sites give patients the ability to go online to make and change appointments or obtain laboratory test results. These Web sites can also assist with accessing old data and making it available to other physicians.

More than 30 social media applications can be used to communicate with patients and referring physicians. Twitter is one tool that Dr. Grogan uses regularly.

“If I’m delayed in the operating room, patients who have appointments in the afternoon receive a ‘tweet’ to let them know that I’m going to be late,” he said.

Coordinating care
Dr. Grogan underscored the benefits of coordinated care by offering the example of the care a snowboarder with an injured wrist might receive.

If the snowboarder is injured on a mountain relatively far from his home, said Dr. Grogan, his injury will likely be splinted by a local physician, and the patient will be sent home for definitive care.

“Once he gets home and needs to be seen by an orthopaedist, where does he go?” asked Dr. Grogan. “Does he go to the emergency department (ED), an urgent care facility, or an orthopaedic practice?”

Dr. Grogan noted that in 2006, there were 125 million ED visits in this country, approximately 20 percent of which were orthopaedic-related.

“The average cost for an ED visit is $956,” he said. “It may take hours to be seen, and patients rarely receive definitive care.

“If you take my entire overhead cost and divide by the number of patients visits I have per year, my cost to see that patient is $71,” he said. “So, these are reasons why we have to consider coordination of care and understand how to do this better.”

Taking “technology baby steps”
Dr. Grogan notes that although technology has many benefits, orthopaedists should weigh their options carefully when considering whether to implement a new technology and should be sensitive to patient privacy issues.

“Not all technology is useful or cost-effective,” he said, adding that before implementing a new technology, orthopaedists should determine which problems they wish to solve.

“Taking baby steps is better than not walking at all,” he said.

“The bottom line,” he added, “is that what’s good for patients turns out to be good for physicians.”

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org

Learn more…
And get CME credits with the “EMR & Other Technologies: Revolutionary Change in Orthopaedic Practice” course, June 11–13. The focus on technology, selection criteria, barriers to implementation, and more will help you determine what works well for practices like yours.