I've been working on an analysis of EMRs (and replacement of a PM) for a 30-provider, 8-office primary care practice in Chester County PA. I've reviewed proposals and demos for all of the top commercial vendors selling to the ambulatory (i.e., non-hospital) market. I've also read every rating and analysis done by other people. I've spoken with at least two practices which have implemented each commercial product.
Some of the key points: 1. No matter which system, no matter what the size of practice, location, cost, etc., the practice would never return to paper charts. 2. There is generally little net increase in provider productivity that translates into seeing more patients within the same time frame. There is also no net decrease however, although there usually is a modest loss of productivity when the providers and others first use the system. Users are usually up to speed within days or weeks. 3. When providers do see increased productivity, it is in the form of leaving work on time. An electronic system also allows providers to log in to the system from home or elsewhere, so "lifestyle" is enhanced (assuming people actually want to "spend more time with their families"). 4. Transcription costs are usually eliminated. This obviously can be a material amount, if providers do a lot of dictation. 5. There are savings from the elimination of clerical medical records personnel and attendant occupancy and office materials expense. In most practices this is a noticeable amount, but the savings obviously vary by size of practice. 6. Universally providers code higher than with manual systems, so revenues increase with the same mix and volume of patients. The amount can be modest or quite large (10%-20% increase in revenue). 7. All practices show at least some positive financial return on investment. Some recoup their investment in as little as 12-18 months, so the ROI over a several-year time horizon can be enormous. 8. All providers confirm that quality of care is better. This is due to automated checking of drug interaction, to more time being available to treat and listen to patients (rather than doing paperwork), to having a complete, instantaneous, comprehensive view on the patient's condition at the time of encounter, to better disease management and so on and so on. 9. Device usage varies. Most practices give providers wireless tablets to carry around. Some give the same to clinical assistants. Some stick with wired devices. A few throw in the use of wireless PDAs, but usually limit usage to nurses and assistants who need to enter only the most basic data and who prefer to carry around smaller devices. 10. VistA and VistA-Office are viable alternatives to commercial systems. My experience with this specific practice is that many providers and administrators who haven't rotated through a VA hospital and therefore have not used VistA are skeptical of the possible benefits of a "government"-developed system. Also it is uncertain to me at the moment how easily either product can be adapted to the average practice. Virtually all practices have PMs (practice management systems). An interface has to be developed with those systems. Interfaces have to be developed for outside labs and for getting prescriptions to commercial pharmacies electronically. The flip side is that I am interested in VistA because I believe it can be enhanced for ambulatory settings the same way it has been adapted by Medsphere for hospital settings. I believe that the functionality of an enhanced system is more than adequate for any ambulatory setting of any size. In addition I believe that any enhancements can be accomplished and the system can be implemented such that the net cost to the practitioner is a fraction of the cost of a commercial system. I am interested in collaborating with anyone out there who wants to pool experiences, etc. If anyone would like more information on my work or me, please contact me at [EMAIL PROTECTED] Wendell Murray -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.344 / Virus Database: 267.11.1/104 - Release Date: 9/16/2005 ------------------------------------------------------- SF.Net email is sponsored by: Tame your development challenges with Apache's Geronimo App Server. Download it for free - -and be entered to win a 42" plasma tv or your very own Sony(tm)PSP. Click here to play: http://sourceforge.net/geronimo.php _______________________________________________ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
