Family Practitioner Uses WRS EMR to Strengthen Ties with Patients

Can a physician who has been a paper aficionado while in practice for almost three decades find satisfaction with an EMR? Just ask Dr. Audrey Spencer, who opened her eponymous practice in Maysville, KY in 1999 to specialize in outpatient chronic care and health maintenance.

WRS Owns the EMR Space

With medicine trending toward EMRs and Meaningful Use incentive payments, Dr. Spencer, a die-hard paper user, decided it was finally time to conduct a Family Practice EMR search. She spent two months evaluating systems. In addition to WRS, she demoed six EMR systems, including Lytec and Amazing Charts. “Amazing Charts is basically free and there’s a yearly fee for support, but you really have to do all of the work yourself. I talked to a practice that was using Amazing Charts for three years and they had not met Meaningful Use. Amazing Charts didn’t include billing. I would have had to keep a separate billing program. I wanted an all-in-one EMR system,” she stated.

Noting in her case study that WRS was cost effective, Dr. Spencer added, “WRS was good. I talked to colleagues who have servers and hardware. Maintenance (fees) kills them. WRS is user friendly so I could figure it out. I said, “Okay, that’s going to work.’ It’s very hands on. I’m very much a ‘hands on and do things the way I want them to be done’ physician and WRS let me customize the EMR to exactly what I wanted.  I do a lot of procedures and joint injections and we do a lot of labs in house. I have WRS set up so that all of the things that I do are on the super bill.”

Everything You Ever Wanted to Know About MU

Mastering the use of a new software system when you’ve always relied on paper charts can be grueling, especially if one of your goals is to apply for Meaningful Use incentive funds. “We went live with WRS on April 1, 2012. One day in August 2012, my husband, who is my accountant said, ‘There’s an $18,000 deposit in your account. It’s your Meaningful Use money.’ There are 25 criteria for Meaningful Use that you have to meet. All of these are spelled out and listed. WRS automatically tracks what you are doing as far as meeting Meaningful Use. You can run a report that is set up in WRS and see if you are meeting the criteria. You can click on any one of those 25 items and see whether you are meeting MU and if you are not, you can watch a video about how to meet it. We checked early on and saw that there was one guideline that we weren’t meeting, so we adjusted that. We needed to send patients electronic handouts about their medical condition, so we activated that,” said Dr. Spencer.

Customized Templates do the Work

Documenting patients’ visits and tracking a plethora of health maintenance services can be a daunting task. Not so for Dr. Spencer. “I completely customized my Health Maintenance templates. For example, when I do an OB/GYN exam, I do the same things over and over again. You are examining the same body parts. You create a test patient template, fill it out for the ideal patient, put in the physical exam findings and the common things you order, such as mammogram, physical exam and stool occult blood. I have broken it down into age categories because the timing and what you do is different. You put that in the template and it is preloaded, so all you have to do is tweak it for anything that is not normal for that patient and you are done. You don’t have to enter your whole complete physical exam on every patient, every time because most of the time it is all the same. It saves tons of time,” said Dr. Spencer.

Dr. Spencer continued, “Medication reconciliation is integrated into WRS system. You do it automatically as you go. It monitors whether you are tracking vital signs. It knows if you are doing patient demographics. It’s all the things you are doing anyway, but it’s tracked automatically for you,” she said.

Ordering Tests Quickly

WRS Order Tracking is also enabling Dr. Spencer to practice more efficiently. “You basically create your own electronic super bill so when you want to order something on a patient there’s a whole page of all the things you order all the time. Instead of having to hunt for things one by one, you just click them and add them in as procedures or orders. For example, for immunizations, blood work and X-rays that you commonly order, you can set that up exactly how you want it just like you can set up your own paper super bill. There’s a drop down list. If you have a new patient you have your list, hypertension, high cholesterol, diabetes. You can customize that list so it only shows the things you care about.”

Tracking Disease States is Crucial

Physicians who specialize in treating chronic care patients can become stymied when it comes to keeping track of the myriad services and procedures that they perform. “I have joint injections preloaded. I even started tracking the steroid and Lidocaine® that I use with the lot numbers preloaded. If there is a recall of that medication I can quickly know which lot I used and what medications I used. I am tracking more than 40 things in health maintenance, including flu shots, pneumonia vaccine, tetanus boosters, kidney disease screening( eye exams), diabetic, (foot exam, microalbuminuria, A1C), well women exams, annual preventive exams and Medicare wellness exams. We track all of that so we know when they are due. I had a one page flow sheet before WRS, but it wasn’t really disease specific. It was more general. I tracked it before with paper, but it was much less refined than it is now with WRS,” said Dr. Spencer.

Abiding by the Law

Keeping up with state laws and regulations affecting medications can be quite a burden on a practitioner’s daily workflow. Pointing out in her case study that last fall Kentucky drug laws changed, Dr. Spencer said, “We have to get on the electronic system to track whether patients are getting Rxs from other doctors and we have to do a urine drug test once a year. I track that to make sure I am doing that in a timely fashion. I have all kinds of things I’m tracking. I don’t even have to think about it. It pops up in WRS,” she said.

Safe and Secure Patient Portal

These days, safeguarding patient information is more imperative than ever. “I can be out of the office and be at home, pull up the records, and check lab work and then I send a message to my staff to call the patient and tell them the results. If I’m at home at night and a patient calls and I want to remember to tell my staff to do something the next day I can log on and send my staff a message instead of having to leave the message on an answering machine. We have patients who use WRS Family Practice EMR Patient Portal. They log on and send us a message if they need a refill or ask questions. We can send our patients a secure message through the patient portal. They get an email that says, ‘You have a message.’ They log onto the patient portal and it’s all secure. With all of the HIPAA concerns, you should not be using email to communicate with patients for any protected information. You really shouldn’t be sending them test results or answering questions about their medical condition unless you’re willing to risk a HIPAA violation, but WRS Patient Portal is secure so you can do that,” said Dr. Spencer.

Goodbye Fax Machine, Hello Fax Queue

Fax machines are old school. WRS Fax Queue is the rage.“WRS Fax Queue is the only thing we use. We don’t have a regular fax machine hooked up any more. If I’m on vacation in Florida I can look at any of the faxes that I need to see. Let’s say it’s a holiday weekend and I want to look at the faxes for some test results. I can look at any of my faxes from any computer. Most of the time my staff matches the test results to the patient and they send it to me as a task and I look at it and it’s in the patient record. If it’s a new patient related fax and it’s important they print it out for me. We use WRS Fax Queue all the time. It’s secure. You don’t have to worry about someone stumbling across your fax machine and seeing the printed pages that they shouldn’t be seeing,” said Dr. Spencer.

For Business or Pleasure

Can a physician really step away from the grindstone without worrying about patients? “When I visit my sister in Florida I take my laptop and log on and check messages. I went on vacation in the Caribbean and I had wireless access where I was staying. I didn’t have to worry about calling the office to see if there was anything I needed to deal with. Of course, I had another physician available for emergencies, but I could log on and see any messages and look at any test results. I didn’t actually have to talk to anybody and I could do it whenever I wanted to. I didn’t have to worry about anything falling through the cracks because I wasn’t available for a week. I didn’t have to take lab results over the phone and listen to lab results. I can go in WRS EMR and look and see what the last lab result was, see what the patient’s diagnoses are and see what their medications are. I’m not trying to do that all over the phone with the staff looking at the chart tracker to tell me what’s going on with the patient,” stated Dr. Spencer in her case study.

Leaving Paper Behind

Leaving a paper world behind is never easy. But, to skeptics who may be worried about making the transition to an EMR, Dr. Spencer offered this solution: “We did not scan in much of anything from the old charts. We entered in the data for pneumonia vaccine and tetanus vaccine so they can be tracked, but we didn’t actually scan in the charts. We didn’t think that was going to be useful. I might scan in an important CT scan report or important lab test that was done before we started going live. But for the most part, we just entered the data in an electronic format with the code so WRS would know that a patient had that test. For example, for colonoscopy, we entered the code for 10 year colon screening and the date so it will track when it’s due again, WRS will know it’s due again.”

Getting Paid for More Services

Increasing revenue is every practice’s goal. “We’ve had an improvement in some of the billing because we are remembering to do the wellness exams and bill for annual health maintenance so that we get paid for those exams. WRS helps to make sure you are coding for the right level. Many doctors under code because they are afraid they haven’t quite coded right, but WRS automatically determines the level of service you documented. All you do is click ‘okay’ and you can override it if you want to. You can change a level 3 to a level 4. WRS definitely lets you code appropriately.”

Dr. Spencer continued, “At a certain age, there’s a preventive visit where you ask, are you living a health lifestyle, exercising, eating healthy, have you had your blood pressure and cholesterol checked, are you up to date on your pap smear, mammogram, immunizations? It’s a wellness review that many insurance companies pay for very year. If the patients are here for a cold and they haven’t had this done, we say, where we are as far as health maintenance? If they aren’t up to date we give them advice on what they should be having done and we get paid for that. WRS Family Practice EMR helps to keep track of this and we make sure we do it every year. Every year Medicare wants every Medicare patient to have a wellness evaluation, which involves reviewing their meds, who their doctors are, functional status, preventive care and it’s basically paperwork. We have it set up a template, and we fill in what we need to fill in and do that every year and Medicare pays well for that at no cost to the patient.”

Patient Satisfaction Tools

Keeping patients satisfied is an ongoing mission. WRS EMR automated calls are helping Dr. Spencer fulfill this goal. “They get the automated call. We also call our patients because some of our older patients can’t hear too well. We use that feature and it is good because if we can’t reach the patient at the time we call, they might get another reminder call. If they set it up that way, patients can get an email to remind them of their appointment.”

Jump Start the Day

Pointing out in her case study that she sees 20 patients a day because she likes to spend time with patients, Spencer said, “I can keep up with the notes as we go and rarely do I have to stay over. I keep up because I have all of my templates and have everything already in. If I have to refer patients, I finish my note, view the note and fax it with a little note to the doctor. I use Dragon Dictation so I don’t have to wait for anybody to finish my dictation. If a patient is sick and I’m sending them to the ER, I can finish my note, fax it to the ER and they’ll have the whole note with the entire patient’s history. The note looks fine. My Medical Assistant uses WRS EMR. When we have patients coming in she’ll get the note started, put in any order we know we’re going to do that day. For example, if the patient is diabetic and the Medical Assistant knows we are going to do an A1C, they’ll put that order in. If we are going to do an EKG, she’ll put that order in ahead of time so they’re ready for the day.”

Linking up with Labs, Hospitals

Dr. Spencer is impressed with WRS electronic lab integration capability. “We enter the labs and when the results come back, they come back directly into the EMR. We don’t have to fax them in. The labs are integrated into the Family Practice EMR. It works really well because we don’t have to look at a fax and match a fax (to a patient). It’s integrated into that patient’s record. We are also hooked up with the hospital, which is really great. We get our ER dictations, notes, labs, X-rays and mammograms directly. I send patients to the ER and I have patients who go to the ER. If my patient was cared for by the hospitalist, we used to have trouble getting the records. They didn’t send the record. We always had to call them to get the results. Now, as long as the patient tells them I’m their doctor, it all automatically comes into WRS EMR. When the patient comes back to see me, I already have that in the record,” said Dr. Spencer.

Quality Time

Finally, Dr. Spencer summed up the greatest benefit she is accruing with WRS cloud Family Practice EMR: “WRS allows for better documentation and better health maintenance. If you are looking for an EMR, definitely look at WRS. WRS training was excellent. I can’t say enough about Resa. Everyone was so responsive. Even once you finish training, you have help. We type in a question and we get a response very quickly.”

These days, Dr. Spencer, who is quite the tech savvy doctor, said, “I’ve always said, ‘They could have my paper charts when they pry them from my dead, cold hands.’ Then MU came into play and I realized I was going to have to make a change. I was going to have to do it so I might as well do it in time to get Meaningful Use. I have a colleague who went live with an EMR last fall and they had only looked at one vendor. I don’t know how much it cost, but I know it’s a lot more than I paid for WRS. My colleague’s patient portal isn’t working yet. I’m a patient there and I couldn’t even figure it out. The patient portal wouldn’t let me log in and I gave up. They had to change clearinghouses and that was a big mess as far as getting their billing straightened out. It’s a very clumsy system. They have trouble finding stuff. Why didn’t they look at WRS?”

Finally, when queried whether there is any truth to the reputation she has garnered among WRS staffers for being the poster child for MU, Dr. Spencer agreed, “Yes. We went live in April and we received $18,000 four months later. But what WRS allows me to do is to provide better preventive care. It gives me more flexibility with where I can access a patient’s records and it allows me to do much better documentation.”

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