Rehabilitation Options of Issaquah (ROI) is a multidisciplinary rehabilitation clinic that cares for patients with back, workplace, and auto accident injuries, as well as athletes to improve their performance. Founded by Michael Hatzakis Jr., MD, a physiatrist, the clinic includes two physicians, physical therapists, a psychologist, a registered dietician, massage therapists, an acupuncturist, an expert in yoga and an athletic conditioning expert.

Despite a mix of practitioners from vastly different backgrounds and charting needs, the clinic has been able to adapt eMDs to its requirements. Pivotal to the success of a multidisciplinary clinic that prides itself on a team approach to care, is the ability for providers to seamlessly and effectively communicate with each other. eMDs has been a key ingredient as it facilitates tight coordination of care. The communication an EHR for medical specialties provides knits the care team together more than would have been possible in a paper-based practice.


Hatzakis is not a newcomer to medical practice or to EHRs. He was part of a practice in Bellevue, Wash., before he started Rehab Options. And prior to that, he worked at the VA hospital in Seattle as an EHR clinical champion and helped develop quality improvement measures through computerized clinical reminders and was an informatics as well as medical academic faculty at the University of Washington.

After struggling with stacks of paper charts and messages at the end of every day in the Bellevue practice, Hatzakis knew he wanted an EHR when he started his new multidisciplinary practice. The EHR solution he sought had to provide good access to information, flexible, easy-to-use templates, and computer-generated notes that referring doctors could read without effort.

eMDs met all of these criteria. It also had an active and highly supportive online users group that he knew would help him collaborate and team up with other like-minded clients.


The implementation process went fairly smoothly, Hatzakis recalls. “eMDs’ trainers were the highlight of the process. We got to know them really well, and they’re top-notch. You can’t help but be enthusiastic when you work with them.”

Hatzakis, the only provider in the clinic with EHR experience, helped his colleagues get over the bumps in the road. His programming skills were not required to implement eMDs, he says. But he did help massage therapists customize their templates. The physical therapists modified the orthopedic templates for their physical exams.

“There was a wealth of prewritten templates in eMDs,” he notes. “We borrowed from other people and leveraged the work of others which made it less work for our practice.”


Hatzakis moved from typing his notes in Word to using the EHR templates. But he still prefers to dictate the assessment part of his notes, using the integrated Dragon voice recognition software, which he says is twice as fast as typing.

When Hatzakis started his new practice, he was busy, because many of his patients followed him from nearby Bellevue. Yet he didn’t lose much productivity during the eMDs start-up period.

“I didn’t throttle back my volume when I started in practice; I didn’t want to turn people away. So I just worked harder for the first few months. But our productivity didn’t drop.”

The hard work has paid off. Hatzakis now sees 15-20 complex patients per day, and performs many procedures in addition to managing the clinic. Yet he still goes home at 6 p.m. and everything is done when he leaves.

The task management feature of eMDs is partly responsible for the efficiency that permits Hatzakis to have this nice lifestyle. When Hatzakis wants to refer patients to another staff member or wants something done for a patient, he simply enters the task into eMDs TaskMan management tool and it pops up in the inbox of the appropriate staff member. The chart is automatically attached so it is easy for the recipient to review information to get context and act upon the task. This is much more efficient, he says, than having to walk across the clinic to tell somebody what a patient needs. And when he gets a phone message or a prescription refill request, one of the front-desk staffers uses TaskMan to alert him so that he can deal with it whenever he has a few spare minutes between visits.

Hatzakis emphasizes the importance of communication in a rehab clinic where the providers must collaborate closely to produce good outcomes.

“They all work as part of our team, and that’s where the power of eMDs comes in. We have a lot of interteam discussions in real time and asynchronously. With the electronic record, we can quickly communicate with each other and that has improved the team efficiency.”


Hatzakis takes pride in the fact that his clinic is totally electronic, except for a few incoming paper documents and forms that must be scanned into the EHR. The practice is using eMDs’ fax management software, so faxes never have to be printed and scanned. All prescribing is done electronically, and the clinic has adapted eMDs’ ordering system to track orders for imaging tests and for sending follow-up visit reminders.


When Hatzakis started Rehab Options, the clinic’s providers were seeing about 20 patients a day. Today, 70-80 patients visit the clinic daily. During the intervening three years, the practice added another doctor and two physical therapists for a total of six FTE providers. Yet the clinic, which now includes 18 staff members and providers, has only two people on the front desk—the same number it started out with. Were it not for the efficiency of eMDs, Hatzakis says, he would have had to hire more staff to accommodate the clinic’s growth.

Meanwhile, he has brought his billing in-house, adding two part-time billers. Because eMDs’ practice management system is integrated with its EHR, those staffers can use the clinical record to check on documentation and coding. Partly as a result, he says, collections are up and rejected claims are down.

Hatzakis is certain he has received a return on his investment in eMDs. “The cost of implementation was quite low, and I’m very happy with the cost-benefit return,” he says. He is also participating in the Meaningful Use incentive program being offered by the federal government, which will add to his return.

Without eMDs, he adds, there’s no way he could carry a full clinical load and still manage his practice effectively without working extra hours. And he loves having remote access to the EHR so he can view information at home when he’s on call.

Finally, he points out, eMDs enhances patient satisfaction. “Patients and referrers see our clinic as well run, coordinated, efficient, and putting patient care first. We can address their questions quickly, and the chart notes go to all their doctors instantaneously. When patients call, their questions are often answered immediately, not days later. So from a patient perspective, that’s a tangible benefit.”

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