Dr. Rich Gremillion had a problem: His practice was spending so much time on patient data entry that patient education was being shortchanged.
“Over half of my time as a physician was being spent with data input. Patients were routinely presenting at appointments without historical intake forms being completed, and the front office staff was spending 10–15 minutes per patient completing and transferring personal and insurance data into our network,” said Dr. Gremillion, who is in practice in Sandy, Utah.
So he decided to update his three-physician practice by replacing the traditional intake form with an electronic form.
It seemed reasonable to have patients input the information themselves, so the three rheumatologists set up a Web site with personal access codes for all patients, who then could use the site to provide information about insurance, medications and dosages, medical history, allergies, and other important data.
Some patients complete their data feeds from home; those who don't are asked to come in about a half-hour before their appointments to use dedicated terminals in the waiting room. If patients complete the forms in advance, “when they arrive at the office, the forms are already in the system and are quickly reviewed for accuracy by the nursing staff and are immediately available to the physicians,” Dr. Gremillion said, adding that the waiting room terminals also let patients update their data at follow-up visits.
In the exam room, the physician can use a terminal to review health evaluation questionnaires, pain scales, and other data. Patients with certain conditions are taught to enter this information at every visit after checking in at the front desk.
The new procedures allow Dr. Gremillion and his colleagues to spend more quality time with their patients.
Although patients benefit greatly from the additional educational time, Dr. Gremillion concedes that there are a few wrinkles to iron out with regard to HIPAA compliance. Data entry through the office terminals does not require Web encryption, and so patient narratives could be accessed by others. “There is no access to doctors' notes or lab data. We feel we're HIPAA compliant, but someone with bad intentions could challenge us on the issue of security,” he said in an interview. “We're continuously fine-tuning the system and adding upgrades to make it more secure without compromising its ease of use.”
Physicians considering a system of their own should be prepared for a significant initial financial investment, especially if they need to set up new computer equipment. “A small practice may need only a single terminal in the waiting room, but the more doctors in the group, the more computers you'll need,” Dr. Gremillion said.
If you don't have in-house networking expertise, you'll have to hire an expert. “I recommend that most people begin with a waiting room-based system and hold off on setting up a Web site until their staffs and patients get accustomed to the office system,” he advised. “And be aware that, based on our experience, at least 25% of patients will not want to use the system.”