EMR ROI in the Specialty Practice
Peter M. G. Deane, M. D.
Allergy, Asthma, Immunology of Rochester, P. C.
PMR
AAIR, PC
•4 allergists, 4 allergist/rheumatologists
•Founded 1985 with two founders still active
•Full-time file clerk
•Thousands of clerical & nursing hours/year
•Thousands of square feet, on & off sites
•55-member staff including 35 nurses (mostly RNs)
•Documentation is easy—to do poorly
•Several million dollars per year gross revenue (3%
Medicare B; Medicaid non-participant)
•Governed by Board of Directors (shareholders, all
seven physicians)
•Managed by MBA Practice Administrator
•CMOM & Billing Manager
•12 clerical staff, 1 billing staffer
•“I was hoping to wait until the technology is ready.”
—35 year old M. D.
•Savings from EMR more than offset system cost
•Savings from reduced supplies, printing and
especially labor (>2 clerical FTE eliminated)
LABOR SAVINGS FROM EMR
100
90
•4 offices in 2 counties
•Allergy immunotherapy & 4 infusion chairs.
•2002: Practice Management System selected
•Put workstations where they need to be
•Establish interoffice broadband communication
•Establish vendor support
•Establish internal technical support processes
•Raise staff comfort level with information-age
change
•No significant loss of productivity (schedules
unchanged throughout implementation)
•Data is where you put it, wherever that is
•Every M. D. had a different paper chart style
•Well suited to a cottage, artisanal industry
(preindustrial)
•2005: EMR Search Committee established & search
begins
•General acceptance of EMR in principle by
practice
•Champions chosen from each division of
practice
80
70
60
$ THOUSAND
•8 M. D. & 3 midlevel providers
Incremental Adoption
ROI
50
40
30
•2006: EMR system chosen
•Vendor to AAIR to see workflow
•Software customization begins
20
10
0
•As familiar as your old teddy bear
•Labor
•Rent
•Supplies
•Total records cost per year: The key metric for
judging EMR return on investment
•2007: E-prescribing & document scanning start
•Document scanning is clerical, a back room
process
•Clinical staff have to adapt to only one EMR
component
•Doctors can adopt at own pace
•Clear benefits
•Can use for CPOE internally too
•2008: Electronic messaging
•Better internal communication
•Messages in system and IM also
•2009: Electronic encounters
•Allows for more perfect coding
•Speeds billing  shorter A/R
•2010: Patient portal
•Provides HIPPA-compliant Internet messaging &
bill pay
2007
2008
2009
TOTAL SAVINGS FROM EMR
100
90
80
70
60
$ THOUSAND
•Dual specialty practice dedicated to the care of
adults and children with allergic and rheumatologic
diseases in Upstate New York
The Paper Medical
Record has substantial
costs.
EMR
50
40
30
20
10
0
2007
2008
2009
To be presented in full at MGMA 2010 Annual Conference
Current Implementations:
•Electronic charting
•Lab interfaces
•Goal: paperless by EOY 2010