Case Study

Remote access anywhere at anytime
Elimination of transcription costs and detailed reporting
Superior interoffice communication due to organized data

As a family practitioner and President of RI Primary Care Physicians Corporation, an independent practice association (IPA) in Cranston, RI, Dr. Al Puerini was looking for an EHR that would help all the primary care physicians in his group improve on the inefficiencies of "fumbling through paper charts."  After reviewing more than two dozen EHR products that were too complicated, too expensive, or too specialty-oriented for their needs, Dr. Puerini and his team set out to build their own system, which they designed and tested over the course of three years.  Eventually, they expanded and refined this homegrown tool into a company called Polaris Medical Management. The result of their labor is now a full-blown CCHIT certified EHR product called EpiChart.

According to Polaris Executive Director Noah Benedict, "the biggest impediment to making the change is not money—it is managing the change and handling the work.  Getting up to speed with an EHR is a long process—it may take you three to six months to fully utilize the chart.  Questions need to be asked upfront during the planning stages: Have you discussed the implementation plan?  What is the training schedule, and how much does it cost? When you bring another provider on, or there is staff turnover, what will be the costs associated to getting them the training they need? You need to get all these questions ironed out prior to selecting an EHR and signing an agreement."

Dr. Puerini believes that primary care physicians have special needs that require flexibility in the way data is entered and notes are written, which had to be addressed in designing an EHR. "Physicians need to have flexible templates.  They can’t be difficult to change. I work with six basic templates and I’ve built variations of those.  That is all I need."

Dr. Puerini says the benefits of utilizing an EHR are well worth the frustration and the extra work it takes to make the transition from a paper to an electronic chart. "It required that I stay an hour after work every evening for the first several months.  To go from all paper to paperless is a huge undertaking. The other two physicians in my practice had just gotten out of residency and had never seen a paper chart—where I had only paper charts."  He adds, "It would be crazy not to start with an EHR coming out of residency."  

Better Care "Utilizing an EHR has improved my quality of life and the care I give my patients. That's my most important return on investment. It has made my care better because things are so well organized and I have clearly documented information at my fingertips at any time and any place. That makes it safer for my patients and a better experience for me.  And when I leave the exam room, I am done. My notes are written, my scripts are electronically sent or printed, my electronic labs have been reviewed, my x-rays have been ordered. My assessment and plan have been charted."

Better Access to Information One key benefit is easier and faster access to information such as lab data.  "The amount of lab data a primary care doctor has to review every day is easily a two-inch stack. All that data now gets entered into the system electronically by category, which is much easier. Staff used to put a stack of charts with sticky notes on my desk and I would have to paw through them to find the last lab and then write a note back telling the staff what to do. Now I have my PC, I type in the patient name, pull up all the labs, and send an interoffice email to my assistant. Just like that."  With the time saved by using an EHR, doctors can spend more time with their patients and see more patients if they choose to.

Better Communication Using an EHR also improves communication with other physicians.  "I can't tell you how many times I have gotten compliments from others physicians when I sent out an ambulatory consult. I hand a clinical summary to the patient in an envelope, and now they don’t have to spend ten minutes taking a medical history."

Better Performance Measures The EHR also allows for reporting capabilities that are not possible with paper charts. "In order to see how I am performing as a physician, I don’t have to rely on health plan data. I can use my own tools. I can see, for example, all males between ages 30 to 60 who have had an A1C in the last 3 months.  Or, when Vioxx was recalled, I ran a query in 10 minutes and had every patient in the practice and their phone numbers ready. I had all patients off Vioxx before the end of the day. Imagine how awful that would be with a paper chart!"

E-Prescribing Dr. Puerini also benefits from the advantages of e-prescribing. "For 20 years every script was on paper—never once was something documented. Scripts were written on paper and gone. Now we have the security of sending prescriptions electronically and every new and refilled prescription is saved in the record. There are no more questions."

The Future of Health Care "My goal is that what we are doing will filter down to other docs. To provide better care for patients, to go beyond what a doctor can typically give the patients.  Because my patients are getting more attention now, I am already seeing better medication management, lower blood sugars and higher patient satisfaction." 

Once physicians find a system they are comfortable with and begin using it, the next step is interconnectivity.  We are laying the foundation for this next step—to connect through RI’s Health Information Exchange, currentcare.