“A big feature that impressed me was WRS ability to customize and create templates and to change things when I'm documenting.”
Oh, Baby: Opening a Pediatrics Practice with a Pediatric EMR is Child’s Play
No experience running a business. No knowledge about billing and aligning with insurance companies. No history of choosing a Pediatric EMR. It’s a perfect storm.
Just ask Dr. Joseph Flint, who opened Delavan Pediatrics in August 2012. After working at a hospital practice for four years where he had a staff to lean on, Dr. Flint found that he had several hoops to jump through to get his new solo practice up and running.
“The biggest challenge was doing all of the business things: getting all of the insurances in line, basically running a business, and doing things that other people had taken care of for me. I’ve learned a lot about billing and working with insurances. I just didn’t pay attention to those things before because I didn’t need to. Choosing an EMR was a huge task. Previously, an EMR was provided for me and I just used the system that they were working with,” said Dr. Flint.
Pointing out that he previously used McKesson’s Horizon Ambulatory EMR when working at the hospital, Dr. Flint said, “I knew that EMR was going to be cost prohibitive, and I knew from having worked with it, that it had its frustrations, such as how long it took to get updates.”
Catering to Patients
Delavan, which is located 35 miles south of bustling Peoria, has a population of 1,800. “I draw from four or five county areas,” said Dr. Flint, who has a keen interest in providing patients with integrative, natural and homeopathic treatment options as well as traditional medications. “I have a number of families who have come here for that reason. I don’t sell supplements, but I have an awareness of what can be used as well as other nontraditional treatments such as chiropractry. I know when that is appropriate and what benefits someone would get to make those recommendations. I have a lot of families who have concerns about different medications. They are trying to reduce overuse of medications, and seek options to prevent or treat an infection or disease naturally. There are some natural homeopathic treatments that are formulated for colds and coughs. I recommend some of those when a child is above the age when they can use them. I often recommend melatonin for sleep issues. I also recommend vitamin D, omega 3 fatty acids and probiotics,” said Dr. Flint.
Server vs. Cloud
Just as he is conscientious about finding the right treatment for his patients, Dr. Flint was diligent in his Pediatrics EMR search. “This was a process because I could pick the EMR that best fit my style of work in my practice. I did a lot of searching before choosing. I knew the names of different companies and did web searches for other options to see what was out there. I read a general article about all of the different EMRs then I started picking some and looking through them. I narrowed it down fairly quickly to a few options–Amazing Charts, Practice Fusion and WRS.”
Acknowledging in his review that initially he was unfamiliar with web based EMRs, Dr. Flint said, “I was looking more at the local server based systems. It made more sense for me to keep my start up expenses down. The web based system became very attractive and it made a lot of sense to me. I have a small office and I don’t have a lot of space to store charts or to have a big server. With a web based system I could login at home. Being the only physician, I am on call 24/7 and having access at home or wherever I am is very important. With cold and flu season rapidly approaching, I will get a lot of calls in the middle of the night. Kids tend to get sicker at night and parents are a little more on edge. Anywhere I am, I just need Internet access, my cell phone, and I’m good.”
Dr. Flint continued, “WRS is priced very reasonably. When starting up a new practice that's important. WRS was not the least expensive, but its rich features are worth the price. It was the best system. Practice Fusion is a free web based EMR so you can’t get much cheaper than that. They had a separate billing company they contracted with to do their billing module. The print output wasn’t ideal. The set up and the flow of the charting was not what I wanted, and you can’t overlook that. Things that are free are not always a good deal. The other system didn’t have an integrated billing module, so it really came down to an easy choice. I liked that WRS had everything I needed and that I could change things if need be. It was more flexible and robust than other EMR systems.”
Have it Your Way
Working with only two employees– an RN and one office staffer, Dr. Flint required a Pediatrics EMR that would make his charting easy. “The system came with some of the HPI templates and I've used some of them. I've also changed some of them to my own preferences. That’s what I wanted. I didn’t need a lot of prebuilt templates because nobody does everything the same way. WRS is great because I while I am documenting patients, I can customize, build and make changes. That was a big selling feature. I was used to a system where you had to logout of your charting environment and login to your training environment to update your template. It took about 12 hours for that template to go active and then you had to logout and login to your charting. I gave up on trying to make templates and I just free texted most things. Now, with WRS, the customization is easy and quick. I can change things. I can say, ‘Oh, I’d like to have this’ and I can customize that for the next time that I want to use it. For example, we use the Lead Risk Questionnaire daily. In the well visit, I have that as one of the HPI templates that I pull up. The questionnaire is recommended by the American Academy of Pediatrics and is required in Illinois for patients on public assistance. I have about 20 percent of patients on public assistance. It asks if you live in a high risk zip code, if you have renovated your home, if a family member works at a place with lead or lead dust exposure or if your home is old. It screens those questions and allows us to input quickly without fumbling through a bunch of papers or having families fill out a lot of papers. We have it right there in their chart. I was able to put that into the HPI template allowing the answer to be clickable by my staff. That was a most useful template to have.”
Dr. Flint has also modified his well baby checkups to include questions that he commonly asks regarding feeding, whether they are formula or breast fed, how much formula, for how long, bowel and bladder function, and sleep patterns. “I was able to customize those and it serves to prompt me to have good flow and to make sure that I ask all of the questions that are important. I haven’t had to make a lot of modifications in the development area of the prebuilt templates because they are so good. I’ve just made changes to other parts of the templates that better suit my flow, but some of the prebuilt aspects were great so I’ve kept those. I like to be able to blend, and have these prebuilt and be able to modify them to suit me better,” said Dr. Flint.
E-Prescribing is a Must
Pointing out in his review that almost all of the medications that he prescribes are sent electronically, Dr. Flint said that his patients are happy that they don't have to bring the script to the pharmacy. When they get to the pharmacy, the pharmacist has the script in his possession. “Potential drug interaction warnings are loaded in WRS. The checks within WRS ask about dosing so that I may check to make sure that everything I have is accurate. The built in checks that WRS has are really good. Before e-prescribing, you would get a lot of calls from the pharmacist saying they can’t read the script. My handwriting is not bad but when I was in training, I knew what it was like to be unable to read some writing, so e-prescribing helps the pharmacists.”
Please, Leave a Message
Dr. Flint was also keen on starting his business with a Pediatrics EMR that boasted a patient portal. “I was impressed that I can communicate with patients via WRS patient portal. I appreciate that patients can access the system and update their medical history and information. They can also schedule appointments and that is beneficial to the practice. I wanted to be able to put more choices and freedom within the hands of patients,” asserted Dr. Flint in his review.
Dr. Flint pointed out in his review that he is also using the patient portal to enable patients to set up their own appointments and to message the office. “Parents may be at work and they can’t use the phone to call us so they can log in to their account and send us a message and we can send a message right back to them. They are e-mailing about appointments or conditions their child may have. We either give them a call, or send them a message back. It’s nice for the families if a child is sick at night and they know it’s not bad enough to go to the emergency room, but they want to make sure they get an appointment for tomorrow. With the portal, they can just get on to schedule their own appointment and send a message for us to see in the morning. It helps families because they don’t have to be on the phone with a sick kid, and know they can be seen the next day,” asserted Dr. Flint.
Billing is a Cinch
Inefficient billing systems can cause physicians to lose sleep. “I was really looking for an EMR with the ability for charting and billing to be connected easily—a seamless connection is what WRS offers. I like the integration. I was looking at another company that had charting, but you had to go with another company to do the billing. They were somewhat integrated but if you didn’t register the patient in one system first, you’d have to go through and register them in the other one so you’d have to remember which way to do it. WRS saves a lot of time when you register the patient, do your chart and create a claim. It populates the claim form automatically. Only a few modifications have to be made. I am more efficient because all of the insurance information and codes that I enter in the note, auto populate. I am the billing person at this time. There’s just not a lot of time required. WRS saves me money because I don’t have to hire a billing person.”
Faxing Made Easy
Having an efficient way to receive and record lab results is crucial. “We use the fax queue and that’s been working out nicely. We give the number out to the labs that we use and they send us the results in the fax queue. It goes right into the system and then we can pull it up. WRS lets us know when there is something there to look at; we then pull it up and attach it to the patient’s chart,” said Dr. Flint is his review of WRS Pediatrics EMR.
What did Dr. Flint think when he found out that a physician created WRS? “It wasn’t created by a computer programmer or a committee of people with no clinical knowledge. It was created by someone who knew what the frustrations were with EMRs and what was needed to eliminate those frustrations,” reported Dr. Flint.
Learning how to use a new EMR system can be a nail biting experience for a physician. “WRS was very helpful. Whether by e-mail or phone, being able to set up a time to do a phone conference has been very helpful. With the help of WRS employees, the training went really well. It helped speed things along and it wasn’t difficult.”
Taking an EMR Test Drive
Like a car buyer who can only get a real feel for a car during a test drive, physicians can surely benefit from trying out an EMR. The problem is that most EMR companies don’t offer this opportunity. “Another feature that was really nice with WRS was that I received an e-mail from WRS asking if I wanted to try it. I logged in and explored it on my own. I clicked buttons and checked things out at my own pace, taking some time separate from the sales type of situation. I wanted to explore it myself and see how intuitive it was for me. Things don’t come across intuitive when someone selling is walking you through. They gave me that ability. WRS gave me a login so I could get into the system. They gave me a few days and they said, ‘Let me know when you are done.’ I said, ‘I’m glad I didn’t go with anyone else. This is a really good program, a really good system.’ That was huge customer service kudos to WRS for allowing me to do that.”
Going through the sales process can be a major hassle for a physician who is shopping for a Pediatrics EMR while worrying about starting a business. “I liked that WRS was upfront. You didn’t have to hunt for information about it, especially with regard to affordability. With some other EMR companies, you can’t find anything anywhere about how much it costs. You have to give them information and hear back from a sales rep first. There are so many e-mails and I just wanted to test the EMR. So WRS gave me that opportunity to test it out. The price was online. It was right there so I knew going in how affordable it was going to be. I didn’t have sticker shock,” said Dr. Flint.
So now that Delavan Pediatrics is open to the public, how does he like being on his own? “I was in an office for four years that was only 25 minutes away so I was able to bring a lot of patients with me. The closest hospital is 15 miles away. We are kind of in the middle of nowhere, but there are lots of families in the area. A lot of families in my town were driving 15 minutes to go to a different pediatrician. They said, ‘There’s a pediatrician in town, I’m coming here.’ It’s nice to see the families that have come with me. Last week, I saw 31 patients, which isn’t bad for starting up. I was used to seeing 15 to 17 a day with the other practice. If you get above 20 it’s just too crazy. Parents want to spend more time with you. Definitely when starting my own practice and branching out you lose some of that because not everyone is going to follow you. We are averaging six patients a day, which I’m happy with.”
Dr. Flint is also very happy to be able to work close to home. “With my previous job, I drove 25 minutes each way to work. I knew that over time as my kids got older and towards school age, I would want to be closer to home, to the school, to be able to take part in their activities. If there is something special going on in school I could block some time out and go. I couldn’t do that if I worked 25 miles away, I’d have to block out a whole morning to come down for an hour. I have two children, a two-and-a-half-year-old and a five-year-old, who will be in kindergarten next year. Being in the community I’ll get to know the school and develop a relationship with them. I’m happy when I can go home for lunch every day. I get to see my wife and two boys. It has made a difference for the boys and my wife gets a little breather.”
Looking back on how he found the office space, Dr. Flint recalled that a friend who has a pharmacy in town was going to rent space, but it would be too costly for him to convert the space. “He let me know about another building. The owner was looking at some point to sell. I ended up getting this building, which was built in the mid 40s to 50s and has a doctor's office but had not been a physician’s office in 15 years. I had to redo walls, paint, remove carpeting and put new flooring in to just brighten it up and clean it up. I am not too much into the cartoony, bright color. When kids are sick, the last thing they want is to be bombarded with bright colors and intense things. We went with a very subtle color palette. We went back to make it try to look like it did when it was built. We decorated the walls with vintage health posters. It has a vintage feel to it. Even the way we set up the rooms. I kept things more old fashioned. I have new sinks but they have that vintage look,” he said.
Who says a busy pediatrician can’t find time for family and hobbies? “I now have time for my main hobby which is woodworking. I think overall, an EMR does save a lot of time. I leave when everyone else leaves here. I’m not at work finishing up things or doing charting. I’m able to get home sooner, spend more time with the family, and have more time for my hobby. I mostly have been making furniture for the house. My next project is building a bed for my two-and-a-half-year-old. Using red oak, I built one for my five-year-old a few years ago. That turned out well.”
So what does the future hold for Delavan Pediatrics? “I plan to apply for Meaningful Use. It was never a focus of mine or a priority, but it was an added bonus with WRS,” said Dr. Flint. While the practice is still new, the thought of hiring another provider has crossed Dr. Flint’s mind. “Down the road, if I hire another provider I would need to have a satellite office,” he said. Will an EMR help in this endeavor? “Sure, an EMR would help,” answered Dr. Flint.