THE DIABETES CENTER
K.C. Arnold, a nurse practitioner in Ocean Springs, MS, was under severe pressure in the fall of 2005. In the aftermath of Hurricane Katrina, the endocrinology group she’d been working for had closed its local satellite clinic. Yet the need of the patients with diabetes in the region was greater than ever. She decided to open her own clinic in Ocean Springs— and to launch the office with eMDs’ EHR and practice management system.
Arnold had been using eMDs in the endocrinology practice since 2000. So she was already familiar with the charting and scheduling features of eMDs, although she didn’t yet know how to use the billing module. The nurse who would become her first employee had worked with eMDs, too. Because of this familiarity and because eMDs was so easy to use, it was the natural choice for her new clinic, Arnold recalls.
Realizing that the local diabetes patients needed care urgently, Arnold was determined to open The Diabetes Center within three weeks. eMDs was up for the task and Arnold was a quick study. eMDs assigned her a dedicated project manager. A local technical support firm installed her computer network, printer and scanner, and Arnold went live on the system the day she opened her clinic’s doors for business in November 2005.
The hard work paid off. In 2007, Advance For Nurse Practitioners’ Magazine named her Nurse Practitioner Entrepreneur of the Year.
And in 2010, Arnold won a prestigious HIMSS Davies Ambulatory Award in the small practice category, competing against physician-led practices all over the country. “I credit my success as a nurse practitioner owner to the use of my EHR,” she says.
CAREFUL COORDINATION TO ACHIEVE RAPID IMPLEMENTATION
The quick implementation of The Diabetes Center’s EHR required careful coordination with local service providers and eMDs. The local IT company worked with Arnold and eMDs’ technical staff to make sure that hardware, software and the network were synchronized. Fine tuning the interface with the clearinghouse for claims filing and electronic remittance advice was also a team effort. But, within three months of starting up, the Diabetes Center was starting to receive payments from third-party payers. A testament to the software’s ease of use is that Arnold learned how to do medical billing at the same time as she was being trained on the eMDs Bill practice management system.
STARTING PAPERLESS, STAYING PAPERLESS, INTEROPERABILITY LEADERSHIP
Not having to scan paper charts into the system proved to be a blessing, because it saved time. Arnold and her staff entered key information into eMDs when patients arrived for their first visits, augmenting it with available lab data. To remain paperless, the practice has used eMDs’ interfacing, computer fax and document management software as much as possible. The integrated faxing allows staff to receive incoming faxes directly into the workflow with easy linking to patient charts and messaging to other staff.
With assistance from eMDs, Arnold implemented an electronic lab interface to Quest Diagnostics. The lab interface automatically downloads patient’s lab results directly into their electronic chart as structured data and routes the result to the clinical staff.
The Diabetes Center was the first outpatient clinic to join the Mississippi Coastal Health Information Exchange (HIE). The HIE gives Arnold online access to clinical information such as discharge summaries and lab results from three area hospitals.
The practice also has eMDs interfaces with insulin pump and glucometer devices. Patients are able to bring in their devices to the Diabetes Center and the receptionist downloads the device data directly into the EHR— extremely useful in tracking patient activity between visits.
The ease of customization of the eMDs system also made it easier for Arnold to deal with the complexities of her practice. “Because of the specialization of what I do—including insulin pumps and intensive management—I needed the flexibility to customize the documentation to fit my practice.”
She has optimized her documentation process. “A lot of what I do for diabetes is repetitive, and I’ve built tons of templates that are fast and easy to use while helping me to adhere to best practices.”
IMPROVED QUALITY OF CARE
eMDs also makes it easy for Arnold to generate flow sheets she can review with patients. At the end of a visit, she prints out the flow sheets and a clinical summary and gives them to the patient along with free educational handouts produced by eMDs.
This helps the patient stay more engaged with their care. “Quality of care was an important goal for The Diabetes Center, and the EHR made it easier to track outcomes and use that data in every encounter,” Arnold notes. As a result, her patients had better outcomes than regional and national averages for patients with diabetes. Although the state of Mississippi does not collect this kind of data, Arnold significantly exceeded national quality standards and standards in the state of Texas (the closest regional state with published data). For HgbA1C, only 24% of Arnold’s diabetic patients have levels exceeding 9%, compared to 56% in Texas and 28% nationally. For hypertension, over 51% of Arnold’s diabetics were well controlled (BP less than 130/80) compared to only 29% in Texas and 33% nationally. And finally, nearly 54% of Arnold’s patients recorded LDLs of under 100, compared to only 30% in Texas and 45% nationally.**http://www.opic.state.tx.us/docs/611_uidetotexashmoquality2009.pdf
EFFICIENCY LEADS TO ROI
Besides providing outstanding patient care, the Diabetes Center has been a financial success too. A reason for Arnold’s financial success, she says, has been her ability to operate a full, busy practice with a minimum amount of staffing. Today, Arnold gets about 20 visits a day—many of them lasting 30 minutes or even an hour. Her practice has approximately 2,500 active patients, whom she treats only for diabetes, a complex disease. Yet she employs just four staff members, including a registered nurse, a receptionist, a biller and a medical assistant. If The Diabetes Center had used paper records, rather than an EHR solution, Arnold adds, “I probably would have needed one or two more employees, in terms of running things around and pulling and filing charts.”
Other time saving functions of eMDs, she notes, include electronic prescribing, computer faxing, the integrated billing function, which automates charge entry, and the eMDs Patient Portal, which allows Arnold to communicate electronically with her patients. She is particularly enthusiastic about the portal. “For diabetes, it helps so much. If I see a new patient and I have to tell him whether he has type 2 diabetes from the initial lab work, I’ll send him a personal message through the portal to say what we need to do next. It’s awesome, because it’s efficient and I know when the patient receives the message.”
Partly as a result of the efficiencies that eMDs created, The Diabetes Center was profitable by the end of its first year, Arnold says. Also within a year of starting her practice, she had paid off the loan she took out to buy eMDs and the associated computer system. Since then, she says, she has achieved a significant return on her investment through lower labor and supply costs and other savings.