Are you manually entering data into your EHR? Or are you still thinking about getting an EHR and wondering how workflow will change and whether it really will save time and money eventually?
The biggest savings of all will come if the rest of your clinical equipment -- the thermometers, sphygmomanometers, ECG machines, even the scales -- can talk directly to your EHR.
By simply eliminating manual recording on paper and transfer of data, either into another section of the chart or into the EHR, workflow is streamlined and more efficient.
And when that blood pressure reading is transmitted directly into the EHR, there are no worries about transcription errors or results that are lost or misfiled.
Plus, the entire practice has access to the data as soon as it's collected. Documentation is improved and that's certainly a benefit in our highly regulated environment.
Most patient visits start with a patient intake process that includes capturing some vital signs. Devices that capture vital signs can connect to EHRs through physical cables (USB or RS232) or infrared RS232 or wireless transmission (802.11b or Bluetooth).
Compare the before and after experience of collecting vital signs that one multi-specialty group experienced by transitioning to digital equipment connected to their EHR:
Before
Vital signs were often incomplete -- temperature was captured only about half the time and pulse only about 10% of the time. Data capture was a two-step process. The RN wrote the results and the doctor added it to the EHR, leaving plenty of room for transcription errors.
After
All vitals were captured at the time they were taken in a single data-transfer process -- from the device directly to the patient record. Workflow was streamlined and data was easily searchable and trended.
In the words of Ryan G. Bosch, M.D., director of internal medicine at the George Washington University Medical Faculty Associates, "The biggest advantage of using digital devices in combination with our EHR is the speed and consistency with which vitals get entered into the clinical record. That allows us to make point-of-care decisions based on current and past vitals that we can see right away, which translates into more accurate, higher quality patient care."
Granted, digital equipment isn't cheap. Automated vital signs devices range from $800 to $1,600. But the high-end, "fully loaded" model takes blood pressure in 15 seconds and temperature in four. It will give a pulse oximetry reading and calculate BMI from the height/weight input from a digital scale (price about $450). It also has the ability to store 50 readings and download in batch later.
Can you imagine a nurse taking a blood pressure in 15 seconds? Think of the time you've saved that can be spent on, say, patient instruction. And in most cases, a non-clinician can take the vital signs -- another cost saving.
A 12-lead resting digital ECG machine will run $1,995 and a 12-lead stress ECG costs $3,375.
But those prices don't need to be a budget breaker, particularly if you rethink your workflow. Instead of equipping each exam room with sphygmomanometer, scale, and thermometer, set up a central triage station. One device will easily support six to nine exam rooms.
Instead of bringing patients directly from the waiting room to an exam room, take them first to the "vitals" room.
If you don't have enough space to dedicate even a small corner to that purpose, consider a cart that can be rolled from room to room. A cart isn't quite as efficient as a single station, and you may find that unless you have one cart for every three rooms, you'll be twiddling your thumbs waiting for someone to bring it around.
With the focus on quality of care and pay-for-performance initiatives it is imperative that physician practices optimize on process improvement that delivers on quality initiatives.
Consider the time and effort involved in a traditional stress test -- even assuming the practice has an EHR -- compared with a digital integrated system:
Manual
Input patient information
Record BP and heart rate
Manage and label ECG paper (10-30 sheets of paper/notes)
Results to MD's inbox for review
MD to ECG reading station, flips 30-page report and does manual interpretation
Report taken to scan station
Results scanned into EHR
Scanned results to patient record
ECG tracing shredded
DONE
Digital Integrated
Electronic transfer of patient information
Electronic transfer of BP and heart rate
Electronic recording of test
MD views results from anywhere
DONE -- half the steps, half the time
Cardiology of Tulsa, a practice with 15 physicians and 10 midlevel providers, saves more than $33,000 each year with integrated stress/ECG and their EHR.
The savings are achieved in product, services, and FTE savings as follows:
- Stress/ECG test paper $8,982/yr
- Shredding service fees $4,000/yr
- FTE savings from few manual/paper processes $7,961/yr
- FTE savings from shorter stress/ECG testing time $12,272/yr
- Total savings per year $33,215/yr
You can calculate your own potential ROI as well. Determine the cost-benefit justification for taking digital vital signs. Manual vitals capture takes about three-to-four minutes per patient (time it in your practice). Digital capture takes about 20-30 seconds per patient, so your savings is about 3 minutes per patient.
What does that mean in dollars to you?
Calculate the number of patients you see a year and multiply that times the net time-savings per test (~3 minutes) and multiply that times the hourly rate you pay the assistants who capture vital signs.
For example, a five-physician practice seeing an average of 100 patients a day will see about 2,000 patients a month, or 24,000 a year.
Time savings estimate = 24,000 patients x 3 minutes = 72,000 minutes or 1,200 person-hours/year.
Opportunity cost savings = 1,200 person-hours/year x $8.00/hour = $9,600/year.
So next time you walk out of an exam room looking for your medical assistant, consider implementing the digital vitals capture -- your assistant will have more time for the high-quality patient care you strive to provide!