Preston A' Zuliani B'Sc', M'Sc', Ph'D', M'D', C'C'F'P', F'C'F'P'

1
Preston A. Zuliani B.Sc.,
M.Sc., Ph.D., M.D., C.C.F.P., F.C.F.P.

• Glenridge Medical Building
• One Belton Boulevard, Suite 100
• St. Catharines, Ontario. L2T 3Y4

2
What is the Hesitation going to a Computerized
Medical Record (CMR)?

• Too expensive?
• No worthwhile advantage to CMR? (Paper
  system works just fine)
• Too difficult / intimidating?
• Other?

3
Transition to a CMR

• 1986 - Introduced computerized billing
• 1989 - Introduced computerized medical records
  (Typed progress notes and profile only)
• 1994 - Add on-line transfer of laboratory
  data from MDS
• Spring 1997 - Started scanning consultant
  reports, x-rays, etc. into CMR
• Summer 1997 - Stopped printing hard copy and went
  paperless

4
Transition to a CMR

• Fall 1997 - Computer hook-up to St. Catharines
  General Hospital
• - Automatic transfer to my office of all lab
  tests ordered on inpatients
• - Allows remote access to hospital charts from
  my office
• January 1998 - Remote terminal installed in
  secretarys home with access to office network to
  do typing at her leisure

5
Our Current Practice

• Three family physicians, one child psychiatrist,
  one chiropractor
• Two front desk staff each with terminal
  phone (one on telephone, other typing,
  scanning, billing)
• One Registered Nurse (own exam room with
  terminal)
• Three part-time staff
• Seven exam rooms (each with terminal)
• Three other terminals outside exam rooms

6
Will it Work For You? How to Get
Started

• No need to be a computer expert
• Use computer just like TV or VCR
• Be sure to choose a vendor that provides superior
  support
• Should you transfer paper to PC or start with
  clean slate?
• Be prepared to invest some time initially
• Back up files

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Advantages

• More efficient
• All aspects of medical records instantly
  available at any terminal
• No pulling charts
• No need to file x-ray reports, laboratory tests,
  consult notes
• No lost charts
• Old, inactive charts instantly available
• Faster generation of sick notes, prescriptions

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Advantages

• More efficient
• Easy for doctor and staff to document phone
  advice, scrip renewals
• Instant generation of WSIB reports
• Instant reproduction of whole chart for records
  transfers or legal requests
• Profiles available for
• - Patients to carry - Consultants
• - Nursing homes - Insurance companies
• - Hospital chart - Faxing to ER

9
Cumulative Patient Profile

• More important to maintain CPP in electronic
  record than in paper charts
• Location for searchable data (Computer does not
  know patient has family history of colon cancer
  unless entered under Family History)
• Medication list, allergies immunizations all
  generated automatically
• Problem List and Personal History dictated
• Recommend patient fills out questionnaire on Past
  Health and have staff enter data

10
Cost Considerations

• CMR must either generate increased gross income
  or decrease overhead expenses by amount at least
  equal to cost of system
• Costs include hardware, software, installation,
  training and maintenance of both hardware and
  software
• Savings stem from greater efficiency which
  reduces number of staff
• Several ways to increase gross income

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Costs All hardware, software, network,
training, maintenance support and taxes

• One doctor, four
  computers
• 30,000
• Lease 540/month
• Maintenance 170/month
• Total cost 8,000/year 700/month
  30/working day

• Four doctors, eleven computers
• 75,000
• Per doctor lease 325/month
• Per doctor Maintenance 90/month
• Per doctor cost 5,000/year 415/month
  18/working day

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Savings

• Greater efficiency means lower salary costs.
  Solo doctor must reduce costs by 8,000 to
  justify the system (1/3 employee)
• Currently total of 3.5 FTEs. Anticipate reducing
  to 2.5 FTEs with voice recognition
• No filing cabinets, storage space, paper charts,
  (no fasteners, colour coding, etc.)
• Increased income
• Patient recalls pay significant share

13
Savings

• Billing for uninsured services dramatically
  easier
• Implementing Block fees much easier
• Participating in Drug Studies easier (
  financially rewarding)
• Time savings for doctor
• - Dictation saves 30-40 minutes/day
• - WSIB forms, sick notes, insurance reports
  eliminated
• - Per visit time reduced (10-15)
• - See extra patient/day. Still be finished
  1/2 - 3/4 hour earlier

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Major Cost Savings

• Practice went from 1.5 to 0.8 staff per Dr.
• - Savings of 3.5 staff (0.7 x 5)
• - Savings of 3.5 x 25,000 87,500
• Note Reduction of 0.2 staff per doctor would
  cost justify system
• Dictation automatic generation of WSIB Reports,
  referral summaries, insurance reports, saves each
  Dr. 45 min/ day (could see patients, or go home)
• Note Seeing one extra patient per day would
  cost justify system