John R.E. Dickins, MD

Arkansas Otolaryngology Center

Background:

John R.E. Dickins, MD, is a Board–certified otolaryngologist and fellowship trained Neurotologist at Arkansas Otolaryngology Center in Little Rock who specializes in Chronic Ear Disease, Hearing Loss, Meniere’s Disease, Vertigo, Acoustic Neuroma and Facial Paralysis. Dr. Dickins received his medical degree at the University of Arkansas for Medical Sciences, and did his specialty training at Baylor-affiliated hospitals and The Otology Group in Nashville.

Brief Description of Practice:

The Arkansas Otolaryngology Center is the outgrowth of a practice that dates back to the 1950’s and is one of the region’s premier centers for ear, nose and throat medicine. Additional ancillary services include the first free-standing ambulatory surgical facility in Arkansas and one of the first ENT office-based auditory rehabilitation departments in the country. The Center has 16 physicians who are supported by a staff of approximately 90 medical professionals, nurses, medical assistants and administrative staff.

Full time office locations are in Little Rock (two locations), North Little Rock, Benton and Heber Springs. In addition, the physicians see patients either weekly or every other week in Camden, Cabot, Clinton, Arkadelphia, Stuttgart and Jacksonville.

MIE product used:

WebChart EHR

Description of how practice has implemented the MIE WebChart product portfolio:

Our practice implemented MIE’s WebChart with a minimally invasive approach. We started with a small working group to assist with the initial set-up. It was important that we took our time during the beginning phases to talk about how we logistically wanted the EHR to work in our specific practice. With 16 physicians, we had a very diverse group with individual EHR expectations. MIE truly worked with us to tailor the product based on how we practice medicine in the ENT field.

We started implementation in our main Little Rock office with the basics -- scanning, electronic signatures, dictating and transcribing within WebChart, tasking, and simple point and click exams, etc. As physicians became more familiar and more comfortable with the product, we added more functionality. Now, WebChart is being used in four of our locations and we are striving to become totally paperless.

Impact of MIE on the practice:

• We have reduced costs for paper products – charts, tabs, folders, professionally printed forms; all the items required for maintaining paper charts have been eliminated.
• We have reduced our transcription costs greatly by frequently using point and click exams, op notes, etc.
• Improved patient care by faxing prescriptions for patients via e-prescribing and by never having to search for missing charts. We are also better able to manage our chronic patients with the automatic tasking, to-do lists and the utilization of electronic lab results.
• Improves physician’s way of life. Now when we are on call, we can look up patient records from home without going into the office. We have also noticed that on call doctors are delivering less care during off hours because we are communicating with patients more regularly. The documentation in our charts has improved and we are better able to ensure that orders, reports and correspondence are all properly signed by the physician by using the system.
• Eventually, we will save on storage space for all of our old files. All archived charts stored off site are being scanned into the new system, and the paper shredded.

Dr. Dickins Q&A:

Q: What “symptoms” was your practice experiencing prior to adopting an EHR? How did these symptoms lead your practice to explore the adoption of an EHR?

A: The ENT field has a mix of high volume patients and surgery. On a typical day, our practice might see 300 patients, and conduct over 25 surgeries. Because of this, we needed a way to stay as organized as possible -- keeping our productivity high while also delivering quality care for our patients. It was hard to keep track of charts, and filing at the end of the day became very cumbersome.

In addition, many of our patients move between our practice locations and we were always scrambling to get their records before the appointment or searching for charts for phone calls, etc. Our physicians also work out of our own ambulatory surgery center and six area hospitals. It was difficult transporting charts back and forth, which eventually became prohibitive by HIPAA rules. Now we can view the patient’s information on the screen from any location with web access, saving us time and money.

Q: What were some of the challenges your practice faced in deciding to adopt an EHR?

A: Cost was a big concern for us when looking to adopt an EHR. One of our physicians in particular was very skeptical about purchasing a system. We had all heard of horror stories and we did not want to spend a ton of money for a system that we might have to un-install if it did not work for our practice. Another challenge was that some of our physicians and office staff were not comfortable with the use of a computer. We did not want an EHR that would negatively impact patient flow.

Q: How did you overcome those challenges and decide to move forward with MIE?

A: We looked into several large and small EHR vendors when first trying to make the decision and spent two years researching specific vendors. We even sent some of our physicians (including the skeptic) to vendor sites to experience the products first-hand. There were several reasons why we chose MIE:

• Cost: MIE was very cost competitive and they set up a very attractive payment plan for us. We put down an initial 25 percent and then they allowed us to pay as we added a physician to the system. This enabled us to accomplish two tasks, 1) helped us ease into implementation and 2) helped us manage costs. We did not even have to finance the purchase of WebChart, but paid with normal cash flow.
• Flexibility: Many of the larger EHR vendors were not as flexible with building a system around the way we practice medicine. These bulky, cumbersome systems would have cut about 25-30 percent of our patient appointments each day, deeply affecting our bottom line. Many of these “boilerplate” EHR companies were either heavy on the practice management side and light on the patient side, or vice versa. MIE was able to provide a good combination of both and allowed us to “grow into” the product.
• High Quality IT Staff: We have always outsourced IT people and therefore, have been accustomed to working with high-level IT people. With MIE’s Web-based model, we were able to keep all of our IT systems off-site and have quality staff working for us, without adding full time employees on our payroll.

Q: What specific cost benefits are you seeing as a result of implementing WebChart from MIE?

A: The total cash savings or increased revenue from our EHR system is at least $25,000 for the first year, broken down as follows. We expect even more savings as we grow even further into our EHR.

• Printed materials savings at least $25,000
• Storage for old medical charts will be eliminated in the future.
• No one is being paid to search for charts
• We are starting to see a reduction in transcription costs

Q: Did the implementation match your expectations? What surprised you?

A: The implementation has exceeded all of my expectations. The ease of moving our entire practice into using the system over 7-8 months was almost seamless. WebChart has made our office more productive, efficient and helps us to better manage our time. We did not lose one bit of productivity during the implementation process and we’re seeing immediate cost savings, not to mention, being in a good position to take advantage of the 2010 stimulus funds and the CMS e-prescribing bonus.

Q: What is your advice for smaller practices that are concerned about the price of an EHR system?

A: I would advise smaller practices to look at everything out there. Be sure you can afford it and that you are not going to get in over your head in case it does not work in your practice. Make sure you have enough connectivity bandwidth to make it happen and find a vendor who cares about your business and is responsive to your needs. Also, vendors who focus on one specific medical niche may be too much of a niche player. You want a vendor who is flexible enough to build an EHR around the way you practice medicine without constant additional add-on fees.