Block & Nation, P.A. Winter Park, Florida

This office of four family medicine physicians believed that high-quality electronic medical records (EMR) integrated with a top-performing practice management (PM) software was the future of medicine. In an era of stagnant Medicare reimbursement rates, higher levels of accountability, and skyrocketing overhead costs for health and medical malpractice insurances, medical offices need to use technology to streamline work, increase efficiencies, improve documentation, decrease malpractice lawsuit risk, and improve profitability. Hence, the need for a complete Electronic Health Record system.

Dr. Bradley Block spent six months researching and comparing dozens of different EMRs. The lengthy search revealed that the PM, EMR, and Document Imaging & Storage capabilities of eClinicalWorks are cutting edge and full-service. And his group's top-end EMR of choice, eClinicalWorks, is affordable and priced more favorably than any EMR with similar abilities.

Block & Nation converted to eClinicalWorks in late 2004. It switched from all paper charting to all electronic charting through eClinicalWorks, and from its old practice management software to eClinicalWorks’ PM software. The data migration of over 14,000 patient demographic files went very smoothly. The scanning of paper files, forms, insurance cards, and driver’s licenses was quick and easy as patients came through the office. The staff and physicians quickly learned to use eClinicalWorks thanks to its intuitively designed layout and features; the office manager states that she was a “computer dummy,” but found the software very easy to use and navigate. And most importantly, the office has found the “eClinicalWorks support team has been excellent and timely” in responding to any needs.

Patient satisfaction and quality of care have definitely improved since implementing eClinicalWorks. No longer are referrals “missed” because someone takes the chart away from the referral desk before the referral is completed for a patient. No more searching for the specific person who knows the “right information” when a patient calls back after the office initiates a call; any staff can pull up the telephone message that has been directed toward this patient’s needs. A doctor, a nurse, a referral specialist, and a billing coordinator can all be working with the same patient’s file at one time to address any needs in a timely manner. Additionally, prescriptions are faxed to pharmacies before patients leave the office. Ill patients can pick up their medications when they arrive at the pharmacy without delay; and, no more call backs to refill meds already addressed because of scripts not turned in or lost by patients. Thanks to the “Rx History” in eClinicalWorks, all of a patient’s prior medications can be viewed within seconds; no more searching through multiple encounter notes for the name of a past rash cream or allergy med that the patient wants refilled.

All lab and diagnostic test reports for each doctor remain in his or her review list until the doctor addresses the test or signs off on it; no longer can someone take an abnormal test away from a doctor’s desk and accidentally file it away! And best of all—no more lost charts; any patient file can be viewed from any computer in the office network – endless chart searches are a thing of the past; this is a major time saver for staff.

Some noteworthy features in eClinicalWorks make this software excel in comparison to all the other EMRs that were considered. The “pic lists” and “templates” in eClinicalWorks are extremely fast and simple to use, and Dr. Block commonly creates or adjusts these while talking to patients; also, the template merging ability allows the practice to quickly mix and match multiple templates during a single visit—Dr. Block recently mixed a well Physical with a Sinusitis with a Lateral Epicondylitis template all during one appointment, and all in a matter of seconds.

Thanks to the streamlined nature of the underlying software, Block & Nation can use VPN software that allows the doctors to securely connect from home to review labs through their interface, review written reports, address phone messages, finish any incomplete work, look up patients while on call, fax scripts to pharmacies, schedule appointments for patients that are in the ER and need follow-up, etc; home connectivity is very fast and invaluable.

As an office of almost 20 people, the members of the practice have found the internal email system in eClinicalWorks to be a huge time-saver for communicating messages to one person or as many as desired through simple, rapid emails which create an immediate notification on the screen of the email recipients. There is no longer a need need to leave post-it notes on desks, or send managers for a sweep of all their staff to give them a last minute update regarding something like their Influenza vaccine supply status. The “Alert” system in eClinicalWorks not only reminds providers of preventive care needs for patients, but also helps them track patient specific needs, such as a repeat Chest CT every four months to follow a Pulmonary Nodule or a repeat Colonoscopy in three years to recheck on Colon Polyps; the alerts ensure that they do not forget important tests which not only have important quality of care issues, but also significant medical-legal implications. Additionally, these alerts have helped boost office income by reminding them to do appropriate in-house testing and vaccinations that are recommended for patients with diagnoses like Asthma, Emphysema, and Diabetes.

The practice has a bidirectional lab interface with Labcorp and Quest which provides results directly through the EMR and can be viewed in multiple formats. Abnormal results are easy to spot because they show up in red instead black. eClinicalWorks has wonderful inking and faxing abilities that makes it easy to sign-off and fax back requests for signatures on forms through the EMR. The “Auto-Update” feature provides frequent version enhancements and updates; the software just keeps getting better and better all the time.

eClinicalWorks has made a tremendous positive financial impact on the practice. Payroll is the biggest overhead expense for any primary care medical practice. In the first eight months of using eClinicalWorks, Block & Nation had a significant staff reduction thanks to increased efficiencies:

    * The Family Medicine office went from five
       full-time Medical Assistants down to four;
    * Four full-time Front Office staff down to three; and
    * Two full-time Billing staff down to approximately 1.25.

The doctors started saving over $5,500 per month in payroll and benefitsin those first eight months on eClinicalWorks. In the second year, the office efficiency continued to improve, and the front office staffing further dropped from three full-time employees to only two employees. Additionally, the practice now saves all the money previously spent on paper charting supplies and paper faxing supplies; this has already saved $7,000 in the first 15 months on eClinicalWorks. Using the EMR has also resulted in the doctors charting and billing more comprehensively; in a comparison of a typical month in 2005 on eClinicalWorks versus the same month in 2004 with paper charting, the doctors charged 13% more level four and level five office visits in proportion to the total visits by all doctors in the office. The reimbursement for one extra 99214 and one extra 99215 per day at the 2005 Medicare rate (versus one visit level lower), equals an extra $68/day; when multiplied out 5 days per week over 49 weeks per year, this totals an extra $16,660 per year of income per provider for seeing the same exact patient population. The EMR also ensures that they do not forget to charge for any services provided. When a vaccine or an “in-house” test is ordered, the EMR automatically charges for the appropriate CPT codes. In fact, in the first year on eClinicalWorks, the three doctors who had been in the office for over two years averaged over $20,000/doctor more in income (prior to expenses) despite having a reduced schedule the first two to three months while transitioning to using the EMR and despite having brought in a fourth doctor who was seeing some of the prior patient overflow.

The second year with eClinicalWorks generated even more impressive numbers. The two physicians who maintained a similar work schedule brought in an average of $40,000/doctor additional income compared to the first year (prior to expenses-- the third doctor took extra time off for personal leave). And all these increases in generated income occurred despite Medicare rates having minimal increases in reimbursement rates.

The office is now getting paid by insurance companies faster than ever before with eClinicalWorks (as compared to when using the practice’s prior, nationally well-known Practice Management software). There is no delay waiting for staff to manually enter charges into the system or by having to “Batch claims” in order to send out the bills. There is no delay caused by an old PM billing software creating non-HIPPA compliant data that needs to be converted to compliant format by the electronic clearing house. On average, the office gets paid by insurance plans in one-half the time with eClinicalWorks as compared to its prior software.

In the second year of using eClinicalWorks, Dr. Block’s office implemented ERA (Electronic Remittance Advice) in which claims from all of the major insurance carriers post their EOB information directly into the patient billing data. This sounds scary, but these posts are not “final” or “locked” until the biller reviews and approves the posted financial numbers. Now, the practice saves even more time and money because it does not have to pay a high-priced biller to spend time just typing in numbers like insurance paid “$53.12.” The biller can now concentrate on ensuring that the contracted fees are paid and can fix problems in a timely manner.

In fact, Accounts Receivable usually equals less than $1,000 total for all four doctors combined on all insurances more than 120 days old as well as for all insurances 90-120 days. This balance is now the norm -- not a fluke. The practices much improved insurance accounts receivable has occurred with the same billing staff; the variable that has changed is eClinicalWorks.

With eClinicalWorks, Block & Nation can now copy a whole chart onto a CD (including all scanned-in consults and old paper records); this is a great feature. The medical record person can copy a 400 page chart onto a CD in a just a few minutes (if even that long). The copier machine lease bill has been down by over $100/month because they are printing out so many fewer pages now. And they are also saving a bundle on postage because they send all records as a CD in a little envelope with regular postage instead of in those big bulk $3-$4 envelopes; and best of all, by state law they still get paid the same per page for medical records (regardless of the format).

The office of Block & Nation knows that choosing eClinicalWorks was the right decision. This software has helped the medical office evolve into an efficient, modern platform of patient care that is quality oriented, independent, and financially successful. Dr. Bradley Block believes that they are far better off now by using eClinicalWorks than by still using paper charts. It is also clear to him that eClinicalWorks is constantly working on getting progressively better all the time. The practice has not only broken even on its investment, but as noted, is saving money month after month in addition to generating more income every month. eClinicalWorks is the gift that keeps on giving.