Practice Makes Perfect with WRS Integrated EMR

How can two physicians who see 60 patients a day at their practice, as well as 200 patients at three nursing homes and a hospital, have a smooth workflow and increased revenue? To hear Dr. Veerappan Sundar tell it, the answer lies in using an integrated EMR and Practice Management System.

Sundar Internal Medicine Associates opened its doors in Henderson, NC, 13 years ago. Dr. Sundar is an Internal Medicine physician and his wife is a family practitioner who specializes in Geriatrics. She is also the medical director for three local nursing homes.

“We manage complicated medical problems and mainly treat chronic medical problems, including heart failure, diabetes mellitus, hypertension, and coronary heart disease. At the skilled nursing facility we are taking care of elderly patients with chronic illnesses, such as dementia and we are maintaining their well being,” said Dr. Sundar.

Noting that for four years he used Allscripts MyWay, Dr. Sundar said, “They were going to upgrade to an EMR with a lot of functionalities that would be mainly for larger practices and hospitals. We didn’t know whether we would be using those functionalities and there was going to be a big increase in the cost for a larger system. In addition, it was not completely web-based, even though when we started with them, they said that it would be.”

After evaluating eight to ten systems very carefully and demoing about three systems, Dr. Sundar selected WRS Internal Medicine EMR. “We wanted a smooth workflow, from when patients check in to when they check out. With WRS, everything is taken care of in a timely manner, without wasting the patient’s time, which is important. At the same time, everything is sorted out, from checking in at the front window, to taking vitals, then on to the exam room, to any orders. The person doing this is taking care of everything before the patient leaves the office,” Dr. Sundar said.

Billing Takes Center Stage

“We like that the billing system is integrated with the EMR,” said Dr. Sundar, adding, “Once I see the patient and do the coding, it automatically goes to the billing person to populate in the system, without having to put it in a separate system. The integration is very important to make sure we capture all charges at the same time we see the patient. Since I have been using WRS for billing, it is working great. The ERA and auto posting in WRS that we are using now are both very useful.”

Pointing out in his review that he started using WRS at the end of March 2013, Dr. Sundar said, “I can definitely say that our revenue has increased. Firstly, we are capturing more charges. Secondly, because the billing is integrated with the clinical EMR, a super bill is created, which then goes to the clearinghouse. Once it comes back, we know if there is a meaningful change or correction needed for the claim. We are getting paid faster and capturing more revenue than we were before. The correction may be a simple one, for instance, the patient has a new insurance card and they didn’t key in the number. The claim goes out, gets rejected and then comes to the hold queue. The next day it tells you, a number is missing. Our staff person fixes the claim and sends it back immediately so we don’t need to wait two to three months for the A/R staffer to do that. In the past we didn’t know immediately. After 30 to 60 days when the A/R staffer was doing the A/R she found it. If the claim is delayed more than three months we lose the payment. So, we basically did the service, but we don’t get paid. Now she catches the mistake.”

Dr. Sundar boasted, “For the last month our rejection rate  was 1.6%  versus compared to the national average of about 4% and the median of 3.2%. This is because we are fixing things immediately and taking care of things right then and there with a single system.”

When it comes to attesting for MU financial incentives, having a system that is certified was crucial.“That was something we were looking for when we were looking at a new system. WRS makes it easy for us to get the data to CMS,” Dr. Sundar said.

Fax Queue Is a Time Saver

Happy office staffers make for a happy office. So, what makes Dr. Sundar’s staff happy? “The Fax Queue is one of the features that our front desk and nurse like the most. Before WRS, when someone referred a patient or we sent a patient for a consult, she had to send a copy of the notes. She had to print it, fax it and put it in the chart or scan it in the system. Now in just one click she can send the note and referral to the other providers. It also reduces a lot of paper and the time she spends in doing referrals. She loves it,” said Dr. Sundar.

Tracking Labs Fast

Tracking laboratory reports also gets a thumbs up from Dr. Sundar. “The lab reports now come directly to the system. That is very important. I save so much time because the lab goes directly into the patient’s chart in the EMR. Every day I review all of the reports in the Order Tracking Queue. The structure of the auto tracking is so well done in WRS. It is easy to keep track of every lab report or any orders which we made to follow up and take action on. Another great feature is that I can send an email from the order queue, where once I view the lab, if it is completely normal I can send the patient an email from there saying the labs are normal. If there are any more questions the patient can always call or I can put it in the pending queue where I can review it later. Once I come to the office I can call the patient and take action,” stated Dr. Sundar.

Appointment Reminders

WRS Appointment Reminders are a win/win/win for the staff, providers and patients at Sundar Internal Medicine Associates. “When we have new patients we automatically send them an email reminder. Patients love it. They say, ‘yes I got a call yesterday.’ It helps to remind them because there are patients coming after three or six months for a follow up or a regular annual appointment. They get reminders to keep the appointment. It is good for them as well as good for us so we don’t lose the appointment time for no shows,” said Dr. Sundar.

Pointing out in his review that with Allscripts, his office staffer spent at least 20 to 30 minutes every day calling patients, Dr. Sundar said, “Now she can use that time for taking care of the patients rather than sitting on the phone calling them.”

Patient Portal Fits the Bill

No, patient portals are not created equal. Acknowledging that he had a patient portal in his previous EMR, Dr. Sundar said, “The functionality was not that good, because they were just starting. WRS Patient Portal is a very great tool. The patient portal is integrated with the system. It is fully functional and it is so great. Once the patient registers, they immediately get a welcome email, which they love. When I see new patients, they say, ‘Oh great I already got an email from you.’ If they are waiting for five or ten minutes, they’ve already looked at the website which gives them a lot of information.”

Dr. Sundar went on to praise the portal for allowing him to make privacy forms, registration forms and history forms available, which patients can print. “They can update the information. I don’t have to add anything that is missing. Everything is already there. I save time,” said Dr. Sundar.

Noting that patients can open and review their lab anytime, Dr. Sundar said, “When patients go to a different doctor or urgent care they can open and show their lab. It’s extremely easy. The portability helps to manage the patient in a better way and it reduces healthcare costs. If the patient was seen here one week ago and had an X-ray for back pain, I inform them it was normal. They can review the result through the patient portal. If he travels to another state and his back pain worsens, another doctor can see the test that they had a week ago or print the lab. They don’t need to repeat the test again because they already had one done a week ago.”

Patient Education

Providing patient education is a cinch on WRS. “I have also put a lot of patient education material on the portal, as well as links to other websites which provide patients with more information. That helps with patients when I say, ‘you need to be on this type of medication.’ If I tell them, ‘your cholesterol has gone up, you need to follow up,’ they click it open and pull different diets to control cholesterol and blood sugar. It makes our patients more informed so they can also take part in the management of their health. It also reduces the time I spend with them so I can take care of other patients. I tell them they can look at all the information in one click,” said Dr. Sundar.

Refills Are Easy

Dr. Sundar is also pleased that if a patient needs medication refills they don’t need to call the office and wait to talk to the office staff. “They just open the patient portal and say I need a refill, it comes directly to me. I send an authorization and they get it, which makes refills easier. Patients don’t need to call, and leave a message, and we don’t have to call them back.”

Health Maintenance

The portal also goes a long way in helping Dr. Sundar provide health maintenance to patients. “Recently one of my patients had a procedure and came in after six months; he had updated his history in the portal so during his visit, I already knew that he had a procedure during that time. That helps me to follow up on what I need to do after that for maintaining his blood pressure, diabetes and medications. There are also certain things we put under health maintenance, such as annual mammography, colonoscopy follow up or osteoporosis screening, which I put in the health screening whenever I’m doing the order. With one click I know what is pending for them to take at that time, so it saves me from having to shuffle around, trying to find when the next screening test is due.”

E-Rx Makes Refills Easy

Noting in his review that many patients have multiple problems and they take medications, Dr. Sundar said, “Some patients require a lot of refills, so electronic Rxs help. On the rare occasion that the e-Rx doesn’t go through to the pharmacy, one of the great features is that you have the option of faxing,” said Dr. Sundar.

Template Time

WRS templates also help Dr. Sundar practice more efficiently. “A lot of patients are on medications, where they have chronic medical problems and they come in for a follow up. There are certain questions we ask every time, so the templates help when we do a follow up for diabetes and ask, ‘what is the range of blood sugar? Is he taking the medication?’ With hypertension, we ask, ‘Does he have any other chest pain, or shortness of breath or other problems?’” I can put these in the template. This helps me so I don’t have to type the same thing more than once.”

The Price Is Right

Pricing weighs heavily on a practice’s decision to purchase an EMR. “We are a small practice so we needed cost effectiveness. We can’t spend a lot in maintaining the system, or purchasing the system, or buying hardware and software because we are primary care. Our overhead is close to 60%. If we spend a lot, it’s hard to maintain, so the cost of the system is very important. I was looking for an integrated system with a low upfront cost so we don’t have to spend too much in hardware and getting new computers every time. The billing, e-prescribing, and lab integration act as a single system rather than having to add and pay capability separately. This is one system with one charge.”

Training With the Right People

Pointing out that a negative experience with his previous EMR prompted him to sign up with WRS for individual training sessions in charting, billing, e-Rx and MU, Dr. Sundar said, “The training definitely helped me a lot and then the webinars were very helpful. The WRS Team is so friendly. In fact, I know all of them by name. Even though I used the previous system for three or four years I never knew any of the people I was talking to. When we had the milestone meeting with WRS, within a few minutes I got so many answers to my questions because they all work together. It’s a great team. WRS is easy to learn and use. Anytime you change from one system to another there will be an initial learning curve, but the learning curve was not bad. We got used to it quickly,” said Dr. Sundar.

Better Documentation

So, how is Dr. Sundar doing when it comes to charting and documentation these days? “Charting and documentation are better now. In the HPA, I am reviewing and documenting better than I did before. When I do my planning, there is a box for each problem to indicate whatever we did. For instance, for a patient with hypertension I can put that I changed their medication. For a patient with diabetes, if I changed anything, I can chart that, which helps with coding.”

Doctor Tested

“Most of the EMR systems are created by engineers and IT personnel. When I saw that a physician created WRS Internal Medicine EMR, I thought it would easily fit with our practice since a doctor knows what we’re going through as doctors. That was another thing that made me look more closely at WRS.

Way to Go

Accessibility was also paramount for Dr. Sundar in choosing WRS. “I do take care of patients in the hospital so sometimes when they go to the ER at night, they don’t have a list of medications they take. When the emergency room doctor calls, I can open WRS from anywhere that I am and see the medications and any problems patients have. That access is very important to manage the patient.”

Dr. Sundar also finds he can access WRS when he is out of state “A couple of weekends ago when I was in South Carolina, one of the doctors called and needed to know about a patient. Immediately, within five minutes I can give him an answer, which is great. WRS frees me up because of the flexibility. If I have something scheduled such as a family dinner, I can finish my work at home because WRS is completely web-based. I don’t need to come back to the office,” stated Dr. Sundar.

On the rare occasion that he isn’t shuffling from the office to the hospital to see patients, Dr. Sundar likes spending time with his family and traveling. “If I have more time I can go home early. We are dealing with a demanding population with multiple medical problems, so we have to spend a lot of time with the patients to sort out their problems and medications. We want to spend less time with the other factors.”

Generous Praise

When queried to sum up what he likes best about WRS, Dr. Sundar said, “The thing I like most about WRS is that it is completely web-based so we can access it anywhere. There’s no new hardware to spend money on, so that reduced the initial expense. When I was getting the information regarding the system, the WRS customer service team was friendly. They gave me all the information that I needed. I was able to contact them many times, which was great. WRS also offers ease of navigation, which is of primary importance, especially because there are times when we are extremely busy. We may see 40 patients each and are able to navigate the system easily so we can take care of all patients’ problems with ease. I like that the billing system and e-prescribing are integrated with the EMR. For a small practice, a system has to be cost effective. WRS also offers great service and the support that I need.

Dr. Sundar’s wife also gives WRS the nod. “Now she says that her workflow is much smoother and she finishes quicker than before,” concluded Dr. Sundar.

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