The Cosmetic Practice is Going Paperless

Cosmetic Surgery Times

September 2008

Just as technology redefines aspects of our personal lives, the next generation of electronic medical record (EMR) tools is evolving to meet the challenges of cosmetic and dermatology practices, enhancing productivity, the quality of care — even patient safety.

At first blush, an EMR system — pathway to the so-called "paperless office" — may appear to be an attractive choice based solely on the significant savings that can be realized in both paper costs and the expense of storing bulky traditional records. But their advantages may go well beyond these savings.

"Having total access is, perhaps, the biggest advantage," says Garett Fortune, vice president of sales and marketing for Workflow.com, a Cleveland-based developer of an integrated system of electronic medical records and practice management software packages of the same name. "[I ask physicians] have you ever been in your office and someone is looking for a chart, and it's not around? You took it to the surgery center, or you're at one office and you need the information on the patient at another office. How would it be if you could pull that information up from wherever you are?"

Dr. Lichten
 
"Just having access to my records 24/7 — no matter where I am — is a lifesaver," concurs Jason Lichten, M.D., director of Central Ohio Plastic Surgery, Inc. in Lancaster and Groveport, Ohio. Dr. Lichten took the paperless plunge from the outset of his practice's founding in 2005 by installing a complete EMR and practice management system.

"There are definite advantages in accessibility and ease of use," Dr. Lichten says. "I have no regrets."

MAKING THE MOVE Eliot Mostow, M.D., M.P.H., professor of internal medicine and chair of the dermatology section at Northeastern Ohio University's Colleges of Medicine and Pharmacy in Rootstown, Ohio, decided that the time was right to go paperless last February, when he opened a second office with new associate James Libecco, M.D., who had previously participated in the transition to EMR at the Cleveland Clinic Foundation.

"When you walk into my office as a patient, I don't want to be typing on a keyboard," says Dr. Mostow. "In the skin care world, whether plastic surgery or dermatology, there are a lot of things you need to mark down and measure as you're doing an exam, and I wanted the patient interaction to be the same or better than if I had a paper chart. Using tablets and an electronic pen, we're really not doing anything different."

Steven Goldman, M.D., director and owner of the Beachwood Plastic Surgery and Medical Spa in Beachwood, Ohio, instituted an EMR system when he moved from a university setting into his own practice in 2006.

Dr. Mostow
 
"When I went from the hospital setting into private practice, we scanned the records of the active patients so the hospital could keep its charts and I could keep copies of my medical records," Dr. Goldman tells Cosmetic Surgery Times. "The exact forms you used with a regular paper system can be created electronically. With a tablet PC, you can write on these forms electronically, much like using a paper chart. If you want to organize the chart in the same way, with tabs and subfolders, you can."

And for those times when paper records can't be avoided — for example, laboratory and pathology results, requisitions, consultation notes from other providers — the scanner provides the ability to create electronic versions of these records to include in the patient chart. "We sign off or document what we need to and then we scan it in," Dr. Mostow explains.

According to Dr. Goldman, "Laboratory records, for instance, can be scanned, and instead of having to go through a stack of papers, I just go through the electronic records."

MITIGATING RISK A second advantage of EMR is the ability to monitor specific risk factors associated with patient care. Flagging potential drug-to-drug interactions or other conflicts based on a patient's allergies, prescriptions and medical history can decrease the sort of simple errors that cause big litigation headaches. Some insurance companies will actually decrease malpractice insurance premiums for doctors because of the automatic safeguards built into certified EMR systems.

"Track activity" is another important means of optimizing patient safety and minimizing risk, according to Dr. Goldman.

"If blood work or x-rays are ordered, or if a pathology specimen is sent out, we can track the orders to make sure those studies are reviewed," he says. "Similarly, if a patient missed their appointment, the EMR can easily flag this patient so they can be contacted to reschedule. Medically and legally, this is an important safeguard."

TEAM EFFICIENT "A paperless solution increases staff efficiency," claims Vanessa Kmet of NexTech Systems Inc., an EMR and practice management systems developer based in Tampa, Fla. "Information is right at their fingertips. They can spend their time on other important duties rather than searching through boxes and improperly filed paperwork."

Dr. Goldman
 
The efficiencies of an integrated EMR and practice management system cover all aspects of office administration, including scheduling, accounting and even billing. In a well-run system, patient information can be submitted to the insurance carrier before the patient has left the office.

"The person who does my billing has easy access to the medical records and they're legible, which my handwriting might not always be," Dr. Lichten says. "And at any point, I can load up the billing module and see where things are and know how we're doing in terms of receivables, getting an idea of everything about the practice at any time."

PAPER-FREE POINTERS For doctors interested in going paperless, physician e-converts advise that nothing beats solid research and due diligence. Several different systems are currently in use in hundreds of practices nationwide, and not all systems are suitable for every practice. All agree the ability to customize a system to your specific practice needs is crucial.

"Take a close look at what's available, then try the products out, hold them in your hands," Dr. Goldman advises. "Talk to companies about hardware, software, maintenance, backups, safeguards and customer service."

Although extensive computer savvy is not required to become a good user of EMR system, thorough training is key.

"Everyone has a different comfort level when it comes to computers," Ms. Kmet says. "Training and implementation timelines are dependent on the office size, and the number of staff and doctors involved."

Interested physicians might also check with local hospitals to determine which EMR systems they use or support. Some hospitals will support the implementation of a system by assisting with costs — in some cases up to 85 percent — if the doctor will consider partnering with that facility for diagnostics or procedures.

"I would tell anyone considering this move to take a deep breath and shop around," Dr. Mostow says. "It's a significant gulp financially and a moderate gulp mentally to give up paper. But in the end, I couldn't go back — and everyone says that. I could not, would not, go back to paper."