Dr. Catherine Faulds

Nightingale's EMR moves practice from paper-centered to patient-centered

Overview

Based in London, Ontario, Dr. Catherine Faulds has been a family practitioner since 1986.  With a roster of 2,200 patients, in 2007 she formed a pilot project with two other doctors to provide patients with access to 24/7 care with expanded services for mental health, chronic disease and obstetrical care..  Their fee for service family health group allows them to run their own offices, but together they hire a social worker, Certified management accountant 2 nurses. Dr. Faulds was the first of the doctors to begin using Nightingale On Demand Electronic Medical Records (EMR) solution in June 2007.

Challenges: Overwhelmed by requests from lawyers and insurers

To describe Dr. Faulds as busy may be an understatement. She runs a family practice, takes on shifts from 5 p.m. to 8 a.m., provides inpatient palliative care at Parkwood Hospital, handles 10 to 15 community palliative care patients and teaches medicine at the University of Western Ontario.  Despite her ability to multi task there was one thing she couldn’t handle: paperwork. “I was drowning in paper. Every day there are six requests from lawyers or insurance firms who want a chart photocopied or clinical records dating back several years,” says Dr. Faulds. “I couldn’t keep up with those stacks of requests.”

A patient may think a fractured foot will easily qualify for short-term disability, but if the patient also has arthritis the insurance company will have a different perspective. It will request a copy of the entire chart to determine if the pain stems from the fracture or the arthritis. Dr. Faulds was finding these requests were turning into an hour of photocopying by her secretary instead of the 15 minutes needed to fill out a form. “Big Insurance companies can bog down physicians very easily by asking for charts to be photocopied, but with Nightingale’s Electronic Medical Records (EMR) it can be done with a few clicks on the keyboard.  The record is also more comprehensive and can be easily read leaving little doubt to translation by insurance or legal firms.  This has reduced my need to do “chart summaries”” says Dr. Faulds. 

Nightingale Solutions in Action

To begin the transformation to a paperless practice Dr. Faulds compared three major  Electronic Medical Records (EMR) competitors. After evaluating each provider’s pros and cons she chose Nightingale On Demand because it was the only one that was web-based and adaptable to her needs.

With Nightingale On Demand a simple Internet connection gives physicians access to electronic medical records in a secure environment no matter where they are. And Nightingale’s general practice management applications provide electronic access to everything from front office functions such as billing, scheduling and patient registration, to back office, patient-centered functions including patient encounters, prescription management, chronic disease management, ordering diagnostics, receiving lab results, and issuing referrals and authorizations. Nightingale also hosts the server; ultimately allowing physicians to focus on patient care, free of technical and administrative concerns.
Nightingale On Demand has given Dr. Faulds the tools she needs to cope with her busy schedule. One of her goals was to be able to work on a laptop while sitting in an arena during her children’s skating practices. Another was to schedule appointments from home when preparing lectures.
But also on her mind were issues surrounding the security of her files. “The College of Physicians and Surgeons has become increasingly concerned with privacy and security issues related to patient information,” says Dr. Faulds. “Paper-based patient information can easily be stolen from the back of a car or home, but given that Nightingale On Demand is a hosted, web-based solution, I don’t have storage or backup issues. Nightingale takes care of this for me in a very secure environment and now if my computer gets stolen it’s not an issue,” says Dr. Faulds.

Results: Unforgettable records, better care

Perhaps one of the best things to change for Dr. Faulds is her role is now supervisory. She hired two part time staff to enter historic patient records, the nurses enter medications and Dr. Faulds focuses on the patient encounters. Those encounters have also become more effective thanks to the standardized templates. “The quality of records is 100 times better than it was before,” says Dr. Faulds. “They’re more comprehensive and have actually jogged my memory.” The system provides a flow sheet which prompts Dr. Faulds to remember about an immunization or an ophthalmology problem. “If you have 21 things you need to do in a visit chances are, without that checklist, you’re going to forget a couple, because you’re human,” adds Faulds. “This actually gives you a template for the encounter which makes the practice of evidence based medicine easier.”

Dr. Faulds’ favorite templates go from the basic – female, male and child physical exam, or the upper respiratory tract exam – to more complex flow sheets.  She designs templates to suit the needs of her practice and frequently uses the hypertensive flow sheet and diabetic flow sheet which all lab work auto-populates. Flow sheets are also an excellent tool for specialist referrals, giving the specialist a complete picture of the patient’s history without requiring her to write full referral letter duplicating the paper chart.

That time spent by Dr. Faulds’s secretary sending charts, records to lawyers and insurance companies has been noticeably reduced. Now Nightingale On Demand automatically photocopies a record or chart that can be faxed directly to lawyers or insurance companies with little effort by secretarial staff. 

Adaptability is key

After only nine months, it’s still a work in progress, but one that Dr. Faulds embraces. As someone who enjoys improving processes, she still uses Nightingale’s help desk to customize her lists and templates. She found the immunization list had only one pneumovax vaccine listed, but there are two forms of the pneumovax vaccine, , one for ages two and up, the other for pediatric patients under two. She emailed the Nightingale help desk and they added the second vaccine to the list. “I like that responsiveness,” says Faulds who admits it must be challenging to gain a general consensus among doctors, given the differences among their practices. “I absolutely love the adaptability and flexibility of Nightingale On Demand,” adds Faulds “I wasn’t buying an EMR that I was trying to fit my practice into, I was buying an EMR that would adapt to the way I practice.”

Computerizing her files has given her the ability to evolve her practice in a way it never could before. “Nightingale On Demand gives you a practice evaluation ability that can lead to administrative changes, improved task delegation, and ultimately research,” says Dr. Faulds. “With the old paper charts we would never have been able to achieve this. It also allows me to improve accountability for my practice by monitoring disease outcomes which is something that the Ministry of Health is going to demand more.”

Future Plans

Dr. Faulds is looking forward to her office amalgamating with the London hospital which uses software that is compatible with Nightingale On Demand. This will allow her to see when her patients are in the hospital and any tests done there will go directly to their chart.

Truly a visionary, Dr. Faulds welcomes the day that a patient can carry their own portable medical record that she could add to at her office. “I’d love to have a web page and have patients look in at their results or look at their chart. I know Nightingale has this service and although not a priority yet it is something I will facilitate for future patient care”.