Enhancing patient care and maximizing OB workflow with an integrated EHR

With offices in Lake Forest and Gurnee, IL OB-GYNE Associates of Lake Forest Ltd. is a busy five-physician obstetrics and gynecology practice dedicated to women’s healthcare. Due to the unique nature of their specialty, they often see patients for many years throughout their lives – from adolescence to menopause – so when you consider the size of some of the patient charts in this practice, efficient communications and documentation is no small task.
Prior to implementing an Electronic Health Record (EHR), they had people carting suitcases between offices with heavy charts. According to Jill Holden, M.D., a physician at OB-GYNE Associates of Lake Forest, “We have patients for 20 to 25 years, so each one of those charts is very thick. In any chart that’s two to three inches thick, it takes a little while to find the pieces of information that you’re looking for.” So, when it came time to move to an integrated solution for practice management and EHR, they looked for a solution that was tailored to the needs of an OB/gyn practice.
A key goal of moving to electronic health records, was to improve access to patient information from remote locations when physicians were on-call and for things such as labour and delivery scenarios.
“We wanted to be more efficient with our medical records. We wanted things to be more legible. From a liability standpoint, we wanted things to be just a little safer,” Maureen Such, practice administrator for OB-GYNE Associates of Lake Forest added. “We wanted to be able to just be able to take care of the patient better by having that information so readily accessible to us.”

Using specialized clinical functionality with an OB chart
Soon after implementation, clinicians and staff quickly gained an appreciation for the EHR versus traditional paper-based patient records. “The ability of the Sage Intergy EHR system, and specifically in the OB chart, is that it affords much more safety in that it doesn’t rely just on somebody remembering,” Holden said.
For example, the EHR can be configured to provide clinicians with reminders about pertinent events, such as performing a glucose tolerance test when gestation is between 24 and 28 weeks. Holden affirms, “It doesn’t seem like anybody would ever miss that, but in the flow of a busy practice, it’s nice to have another check and balance to be able to mark risk factors and highlight it within the health management system when something’s coming due.”
Similarly, alerts within the EHR also notify clinicians of important considerations. “For a patient that’s RH negative – which is important for us to know when they’re pregnant – that comes up in red at the top of the OB chart, so you know to watch out for that,” Sue Ellen Metzger, a certified medical assistant at OB-GYNE Associates of Lake Forest added.

OB/gyn templates provide workflow flexibility
Sage Intergy EHR provides a variety of pre-configured OB/gyn templates that can be used “as-is” or they can be customized to the needs of a practice and to the specific workflows of individual providers.
“One of my partners is kind of our guru for setting up templates. Within a few minutes, she can put together a template that works very well for us,” Holden said. “Somebody will make a comment, such as: ‘I’ve had three patients today with psychiatric complaints that are kind of affecting issues, but I had to go searching for the information on how to apply that to the templates we have in GYNE.’ A few minutes later, she’s got a template up and running.”
“We deal with PAP smears every day and how we manage them with colposcopies and follow-up PAPs and possibly Leaps; she has made a template for that that moves from one section to another, but it’s all on one template. So you don’t have to even think twice – where do I need to go to get the information for this, it’s on one template,” said Holden.

Accessible images, labs and prescriptions enhance care
Clinicians use laptop PCs which they can carry into the exam room with them, or view from a hallway kiosk to gather pertinent information before patient visits. This technology facilitates information sharing not only among physicians but also among patients as clinicians are able to show patients ultrasound images and test results on-screen further engaging them in their healthcare. “Anything that comes into the office that we didn’t directly put there (within the computer), we can scan in, and it’s dated and it’s categorized, so it’s very easy to find within the chart,” said Holden.
The doctor also noted that eliminating labour-intensive searches for lost charts and test results is a substantial benefit. “If I’m looking for an ultrasound on a patient that she had seven years ago to compare it to one she just had now to look at the size of fibroids, it’s at my fingertips.”
This increased organization is also helpful for lab results and prescriptions. Lab tests can be ordered and the results received directly into the patient’s chart. Prescriptions are ordered and routed electronically to the patient’s pharmacy reducing legibility issues and increasing patient safety.

Communications flexibility is key for patients and providers
Clinical tasking enables clinicians to complete various tasks throughout the workday. They can send tasks for routine things like prescription refills and provide quick answers to questions asked by patients calling the office in between appointments rather than putting those things off until the end of the day. Holden said that as tasks are completed and more come in they can be handled between patients. “It’s not 25 or 30 at the end of the day. It’s wonderful.”
“There’s a quality of life issue there. They’re able to work throughout the day while they’re seeing their patients, and hopefully leave at the end of their patients” said Such.
“Communication with patients both inside and outside the office has greatly improved with this electronic health record system,” Holden said. Using the system to securely access patient records remotely to handle after-hours calls has been a big time saver for clinicians. “We are able to access a patient’s chart as we’re talking to them,” Holden adds. “I was on call last night and at 10 o’clock had two phone calls from patients. One had a problem with pain and I could see quickly that she has had the same pain before. She’s had a problem with a cyst, and my partner’s taken care of her. I had never met her, but I felt very comfortable with guiding her on whether she needed to come in urgently or could she wait until the morning.”
In addition to helping clinicians handle after-hours calls, the EHR is enabling the practice to more efficiently handle patient calls during the workday.” When someone calls in for a medical question, what might have taken hours to get back to them before, we can now answer within five minutes,” according to Such.
According to Holden, “We have a streamlined system, we’re a very busy five-person OB-GYN group, and it’s allowed us to function much more efficiently. We communicate with each other much more efficiently, we communicate with the hospital, with our insurance carriers, as well as other physicians. We can have a patient traveling some place out of the state or even out the country, and with a quick phone call, we can get records to somebody in another area.”
“When I want to send a letter, such as correspondence to a referring physician or if I’m referring a patient, as I’m finishing the documentation on my note, it’s two clicks,” Holden added. “It has really streamlined the process tremendously.”

Decreasing malpractice costs and maximizing revenues
Malpractice premiums have decreased as a result of implementing the EHR. “Our malpractice rate in Illinois is very high. We have incentives to lower our rates based on documentation in our medical records, and we get so many percent back for having an EHR, for having a specific OB flow sheet, etc. We brought down our percent of our malpractice rate by 9 percent when we went to an EHR,” Holden said.
The increased capabilities of the practice management system have also enabled the practice to better manage its revenue cycle. One of the key things is “being able to check eligibility before a patient comes in to the practice and knowing what it is that you’re going to be able to collect from that patient and doing it up front,” Such said. She also likes the claim scrubber which checks claims for errors before submission. “Our ability to collect our receipts used to be somewhere between 30 and 45 days. Now I’d say it averages between 14 and 30.”

Proactively engaging patients in their care
The recent implementation of the practice portal enhances communications with patients. With a secure login, patients can access real-time information and services that enable them to actively participate in their care. All of the information securely communicated through the portal can be saved directly to the patient record and can be easily routed for follow-up by office staff and physicians.
“We’re excited about implementing the practice portal,” Holden said. “Some of the things that we’re looking forward to is capturing patient information prior to them coming in for the visit. In addition to that, we are really excited about being able to exchange lab results with patients, and that’s something that always takes a lot of time within the practice.”