Ty Thaiyananthan, MD, founder and head neurosurgeon of BASIC Spine in Orange, Calif., and practice manager Casey Crawford discuss the challenges and opportunities for integrating electronic medical records into a spine practice.
Q: What was your experience with electronic medical record implementation?
Dr. Ty Thaiyananthan: We went through a stage where we were like every other practice; we saw deadlines looming and we wanted to jump into an EMR system. We picked one that was very popular and quickly found out that even though it meets meaningful use criteria, it wasn't the most practical or most efficient system for us.
We made the decision to shop around on EMRs to see what the various features are that could be tailored to our practice. EMRs are created by technical folks with a disconnect from the way real practices operate. If we used the EMR system that we originally started with, it would take up to two hours to actually work up the patient and enter the data field. We started just picking out a few features and using them instead of the entire EMR.
While the system did have advantages for meaningful use and allows patients to access their records, the system as a whole is still challenging. Companies try to provide a universal solution for everyone — spine surgeons are using the same system as internal medicine physicians, cardiologists and pain management physicians — and it's not something that is applicable for every field.
Casey Crawford: There was a four-month period to get through staging the first training process from beginning to end before we could implement the EMR. It would be great if we could have a dedicated team of people from a practical standpoint, who understood the technology and could teach it to the rest. This is also important for new staff members. We have to put people through the accelerated training process. Right now, we have an EMR in place that none of our physicians really understand.
Q: After this experience, have you found a better EMR option?
TT: The answer really belongs in customizing EMR workflow to the practice. The future trend for EMR may not be picking the company with 2,000 options, but the company that has an EMR specific for the specialty: spine or pain.
There are some examples of EMR that are created specifically for specialists, such as ChiroTouch just for chiropractors. Everything from working up the patient to workflow to billing caters specifically to chiropractors. What we've done is found a company that allows us to customize an EMR.
Q: Are there any special features you are designing to optimize the EMR's usefulness?
CC: We'll eventually have an app built for the EMR where physicians can track referrals. The Cloud-based EMR system will allow us to access the App via iPad or smartphone in real time, providing the patient with the needed information on the fly. Patients can also log into the system and pull up their medical records to show another physician outside of our practice their medical records. A lot of times it's like pulling teeth to get medical records from the referring physician, this can eliminate the back-and-forth that can bog down an office.
TT: There are also components that allow communication between different physicians and their patients. There are a lot of communications through the web using email in a HIPAA-compliant way. Physicians can also communicate with each other and patients potentially in real time without having to pick up the phone and page someone.
A lot of EMRs require a very high upfront cost in terms of buying the software and equipment. The advantage of the Cloud-based EMR is that we can license month-to-month at an affordable rate. Some EMR systems cost more than $150,000 for the equipment and software, which is a lot to practices. The Cloud-based system is only a few hundred dollars per month, which is palpable for small and medium practices.
Q: What advantages do you expect this new system will provide advantages over the other platforms on the market?
TT: One of the reasons we decided to build our own EMR was because other systems were not practical to train the staff on because they get bogged down with too much stuff on their screen, which deters them from wanting to use it. A high percentage of EMR is not practical and physicians don't have time to use it. Some companies want 40 hours of training and physicians just don't have that time.
We wanted to make an EMR around the flow of our office so each individual knows what they are doing the first time they pick it up. We want to make it as user friendly as possible. If it's not easy to use and practical, individuals won't use it. You get out of it what you put in. Most systems are useless because people don't use them correctly. The majority of EMR companies will put in bells and whistles to get their sale, but then people don't use them.
Q: There are several anxieties associated with EMR implementation. What would you recommend other groups avoid during the selection and implementation process?
TT: You have to find something that makes sense to your surgeons. The internet went down two weeks ago and one of our physicians was relieved because she could use the paper charts. This is an example of an intersection of technology and physicians. Even though physicians are very smart people, when you start introducing technology to practices, they aren't on top of latest and greatest things.
Companies want to sell you expensive hardware as well as a bulky server. The reality is that most computing right now is Cloud based. There are companies still advocating a server-based platform and physicians don't realize that it will be obsolete in a few years. They make a huge investment and then another huge investment to upgrade. Physicians are sometimes slow to grasp the latest technology and implement it into their practice.
CC: The big three companies are still trying to squeeze every last bit out of their software. They keep pushing it until it becomes without a doubt obsolete. They are obsolete right now, but they are still selling these brand name systems to physicians. It doesn't make sense. The companies are slow to adapt changes because they have large hospital clients on the old system, so they would rather not rock the boat.
Q: Where do you expect EMR to evolve as an efficient tool for physicians?
CC: We expect the EMR of the future to be more customized to each practice. The goal is to improve patient care, reduce denials and tighten the time it takes to receive patient authorizations. This is a smart EMR that can lead us down the right pathway to better patient care.
TT: There are insurance plans that have various criteria that patients have to meet before being approved for a procedure. This EMR helps guide the patient depending what system they are on to follow their insurance guidelines. That helps guide the physician toward evidence based medicine, which is what we would consider the standard of care.
There is also an emphasis on accountable care organizations. ACOs demand quality metrics and protocols with specific evidence behind them. A platform specific to spine and pain can become a tool for the physician — not just an EMR. It helps guide our practices in the most optimum way for the patient.
The complexities for what the EMR will have to do in the future will be a lot more than they do right now. It has to be simple and practical enough that physicians can use it in the office and still meet patient flow criteria and documentation criteria.
Dr. "Ty" Thaiyananthan is the founder of BASIC Spine in Southern California. BASIC specializes in complex and minimally invasive spine surgery and is at the forefront of pioneering new surgical techniques using stem cells and minimally invasive surgery to treat chronic neck pain.
Dr. Ty earned his medical degree from UCSF, did a general surgery internship and neurosurgery residency at Yale and completed a surgery fellowship at Cedars-Sinai Medical Center in Los Angeles. Follow Dr. Ty on Google+.
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