Case Studies
Working as One Clinic on Two Sites
Medical Associates Sunshine Coast
September 2009
The Medical Associates, with two clinics in Sechelt and Gibsons, has been using an electronic medical record system for 12 years and implemented a PITO-qualified EMR in August 2008.
With a total of 17 full time family physicians, the two clinics share one business office located in Sechelt. Physicians, particularly in Gibsons, see up to 50 patients a day. Because physicians use the same EMR, patients can go either to Sechelt or Gibsons and staff can cover in either clinic.
Why an EMR?
Dr. Karen Forgie, of Sechelt, has been using an EMR since 1996 and she was the one who researched and recommended the vendor last year. “We are a small community and we rely heavily on locums. We knew that they were frustrated with the old DOS-based system and that was all the more reason to change,” Dr. Forgie said.
The physicians wanted an EMR with features such as prescription writing and decision support for management of chronic disease patients.
With the physicians on board, the task was left to convince the staff. They were a bit hesitant at first. “Change isn’t too common in this area, but once they could see the benefits of the new functionality, they were interested,” says Barbara Bott, clinic supervisor in Sechelt.
Staff weren’t as eager to change at first because their old EMR took care of billing and scheduling functions quite well. The physicians, on the other hand, were very eager to change because they were not satisfied with the clinical functionality.
- Scheduling appointments
- Generating and recording prescriptions
- Generating referral letters
- Downloading of lab results
- Completing forms
- Scanning and storing documents
- Generating and maintaining patient summaries
- Billing
EMR Features in Use
The Conversion
The Medical Associates’ physicians knew that converting their old patient files into a new EMR wouldn’t be easy. When they informed their existing vendor of their plans, they did not receive very good news. “Our vendor said that it didn’t have the resources to do the conversion in the timeframe needed and that there were going to be issues with data integrity and data corruption,” said Carol Rimmer, Practice Manager.
Finally, a decision was made to convert the demographic data only and create PDF copies of the rest of the chart. This would meet medico-legal requirements and allow the PDF copy of the old chart to be attached to the patient in the new EMR. “It’s not integrated, but it is searchable,” Carol added.
“It’s been a difficult transition. Transferring data from the old charts to new charts is very labour intensive, but we all knew this going in,” Dr. Andrea Stinson, of Gibsons, said. Dr. Stinson decided to take personal responsibility for updating the charts for all her active patients. She printed a patient list and started populating chart summaries with current medications, allergies, and other relevant information.Everyone involved put in a lot of work in the three months leading up to the conversion and, more importantly, in the months following to ensure their success. The conversion created 74,000 files which was an especially high number considering there are only 26,000 people living on Sunshine Coast. Even with tourists, that was a lot of inactive files.
Since the conversion, Dr. Stinson has maintained a busy practice and sees the same number of patients per day. She doesn’t dictate her notes or consults anymore. She types short notes during the visit and finishes after the patient leaves. “It doesn’t take me any longer to type than it did to dictate,” she says. “I sometimes have to go back to the old EMR [to get information], but my patients don’t seem to mind. And the billing functionality and signing-off on notes have saved me so much time.”
What Can Be Improved
Dr. Forgie would like to have tighter templates. “For example, right now we have two templates for diabetes, with the same information,” she said.
Key Lessons and Advice
Dr. Karen Forgie on choosing a vendor:
“Research what your needs are, have a clear idea of what you want – some programs are better with billing, others are better at doing CDM; visit other clinics that are operating on an EMR and ask for feedback and references before you take a decision.”
Dr. Andrea Stinson on the conversion from paper to the electronic system:
“It’s been a difficult transition. Transferring data from the old charts to new charts is very labour intensive, but we all knew this going in.”
Carol Rimmer, Practice Manager, on the benefits of using the same EMR:
“We now work as one clinic on two sites. We can shift staff to cover in either clinic and patients can come either to Sechelt or Gibsons.”