Chapman L 2009 "EHR supports healthier patients and a healthier bottom line."

Chapman L. EHR supports healthier patients and a healthier bottom line. 2009 [cited 2010 February 16]
"Graybill Medical Group boasts 130,000 patient visits per year and annual revenues of more than $22 million. But in the tightly regulated and highly competitive Southern California market, the practice, which serves patients from three site locations in Escondido, Fallbrook, and San Marcos, is always looking for ways to enhance outcomes, increase patient safety and satisfaction, and reduce expenses. With specific quality improvement objectives in mind, Graybill decided to implement advanced electronic health record (EHR) technology in 2004. Following a failed attempt at EHR deployment in 1999 due to inadequate planning and preparation, however, the practice took a much more prudent approach to its digital strategy."

To describe Graybill Medical Group's EHR implementation along with its most distinctive features and how the technology has affected the way the group practices.

Type Clinic
Primary care
Small and/or medium
Urban and suburban
Other Information
The study included three primary care physicians in San Marcos, nine in Falbrook and 21 in Escondido, California.
Type of Health IT
Electronic health records (EHR)
Practice management system
Type of Health IT Functions
The EHR includes "a comprehensive set of features that ... support operational efficiency and enhance care delivery: patient medical records; demographic, medication, and problem list data management; clinical decision support tools; coding and compliance support; order generation; integration with diagnostic systems [such as mammography, x-ray, ultrasound and a picture archiving and communications system (PACS)]; and data transmissions and communications."
Context or other IT in place
"Prior to EHR implementation, Graybill implemented the companion enterprise practice management (EPM) system to maximize the value of the technology and to facilitate paperless information exchange within the practice."
Workflow-Related Findings
"When a physician orders a mammogram, for example, a task is automatically created in the system notifying the radiology department that an appointment must be scheduled with the patient. Upon completion of the test, an outside radiologist reads the image via the PACS and dictates the report, which is loaded into the EHR. In addition, the referring physician has immediate access to an image when the technician completes the test. Graybill subsequently is able to import critical data and automatically associate files with a specific patient, encounter, and category. Results are tasked to the primary care provider for review and electronic signature. The ordering physician then has a complete view of the patient's condition and diagnosis from an office, exam room, or remote setting. Previously, all radiology reports were handled on paper. But with data flowing seamlessly between the imaging, PACS and EHR systems, Graybill providers can monitor care plans and overdue services - and have been able to reduce labor, supply, and off-site storage costs."
Graybill likewise "developed a bi-directional interface ... to facilitate electronic transfer of outgoing provider orders and incoming lab results. When a physician orders a lab test, the request is sent electronically. Previously, orders were printed for patients to take to the lab themselves, creating an opportunity for it to be lost or misfiled. Upon completion of the test by the laboratory, the Provider Approval Queue (PAQ) allows physicians to review the documents and electronically affix their signature, enabling them to make medically appropriate decisions earlier in the patient care process. The completed and approved report automatically will be appended to the appropriate patient's electronic chart."
"Before EHR implementation refill requests represented an 11-step process - including fielding the call, message hand-offs, chart pulls, and more. This workflow process has now been trimmed to two steps, with fewer opportunities for errors or miscues. Similar gains have been realized with patients phoning for radiology and lab results."
"Patients are enjoying increased access to their providers as well. Graybill used its new technology to introduce new processes to trim the "wait time" before a non-urgent appointment with a patient's preferred provider. Implementation of an Advanced Access Program allows patients to see their primary care physician within 3 days. Prior to program implementation, "next available" appointments averaged 18.25 days for office visits and 26.93 for preventive care."
"As a result of [the Advanced Access Program] and other workflow improvements, physicians have been able to see 7% more patients without adding hours to their schedule. Between 2004 and 2007, for instance, patient volume for each of Graybill's family practice providers rose by 310 visits."
"Since many radiology studies such as mammograms are directly linked to key pay-for-performance (P4P) measures, results can be extracted for health maintenance and disease management reports. Rather than requiring caregivers to enter data multiple times, Graybill providers are able to simply click on the appropriate box in the EHR and the system automatically populates the health maintenance record with the appropriate patient data."
Study Design
Study Participants
The study participants included the Graybill Medical Group clinical and administrative staff.