An HIT Moment with ... is a quick interview with someone we find interesting. Gregory Spencer, MD is an internist and chief medical information officer at Crystal Run Healthcare in Wallkill, NY.
Describe your practice and what changes, good and bad, that your EMR brought about since it was installed several years ago.
When our group was founded 13 years ago, we were a single-site medical practice with nine providers and 35 employees. We have grown 20-fold since then and are currently are a 170+ provider multi-specialty group with nearly 1,000 employees and 11 sites. We are opening an ASC this summer. Our growth was mostly from hiring individual physicians and not from mergers of existing groups.
We bought NextGen in 1999. The changes in the EMR since that time have been massive and positive. Initially, the NextGen product was more of a tool kit to help you develop your own EMR. Now there is an extensive template set that comes off the shelf with the product.
The company has grown almost as quickly as we have. They had a rough patch a few years ago where their sales staff outpaced their support functions. They have improved and are doing much better in that regard. NextGen’s product also had issues with speed and scalability in the past, but this too seems overall better.
Practices that don’t have EMRs worry about the physician time they require and the perceived value they provide in return. What is your experience?
EMRs require a lot of time and money to set up and maintain. Once you are facile, EMRs are a lot more efficient than handwriting, but not so much for those who dictate everything.
The value EMR that can return is real, but is largely untapped by most users. Using as many bells and whistles that the product has is more important than you think. Population management is just starting to be done, as an example.
The predominant value EMR returns is most not monetary. You could probably save money by throwing a bunch of low-level file clerks and transcriptionists at an office. You cannot do certain things without EMR, no matter how much money and people you throw at it.
Beyond your EMR and practice management systems, does your practice use other practice applications or connections to outside data sources or information exchanges?
Yes, lots of them. We have a home-grown patient portal for patients to request appointments, meds, etc. We use Televox to confirm over 1,000 of our patient visits a day. We extensively use MS Exchange and Outlook with BlackBerries for remote clinical communication.
We have Orchard for our laboratory information system and are in the process of implementing Carestream as a RIS/PACS We use Citrix both within the office as well as for remote access via its web VPN. We have our own data warehouse that we use for business intelligence as well as clinical purposes.
What do new doctors coming into the practice think when they see the technology?
We have hired 27 doctors in the last six months and will hire another 20 more by the summer. New hires uniformly consider the EMR a positive and often is a deciding factor in selecting our practice. We have merged with a few other groups. Established physicians definitely have a harder time with the EMR.
Have patient outcomes or patient satisfaction been affected by using an EMR?
Yes. We have demonstrated improved rates of mammogram, PSA, and other clinical parameters with a care manager program that uses the EMR. We track patient satisfaction, but have no "before/after" data for comparison.