Dr. Michelle Greiver

Nightingale's EMR improves practice efficiency and quality of care

Overview

Dr. Michelle Greiver is a family physician who has been practicing medicine for 20 years. Based in Toronto, Ontario, Dr. Greiver sees approximately 20 to 40 patients per day.

Dr. Greiver is a member of an Ontario Family Health Network (FHN) - a group of family physicians who work together at multiple locations to care for patients who have signed up for their services. Physicians share on-call duties and extended hours with the support of a telephone health advisory service. Dr. Greiver's FHN, which is affiliated with North York General Hospital, is composed of nine doctors in seven offices across the Greater Toronto Area. Part of the reason the doctors chose to become a FHN was that they knew it would allow them the opportunity to take advantage of government funding programs for information technology, including Electronic Medical Records (EMR).

Challenges

Dr. Greiver believes staying with paper records will make practicing medicine more difficult in the future. More and more participants in the health care system - including laboratories, pharmacies and hospitals - are moving towards electronic systems; physicians will need to be connected electronically as well. Additionally, the next generation of tech-savvy doctors is eager to use the latest technology in their practices. Looking ahead to retirement, Dr. Greiver realizes attracting new associates and finding someone to take over her practice would be simplified if she was using an Electronic Medical Records (EMR) application.

Nightingale Solution

After investigating various solutions from different vendors, Dr. Greiver's FHN chose Nightingale On Demand after another FHN associated with North York General had selected and recommended it. Nightingale On Demand is a fully integrated, simple-to-use system that automates daily tasks, streamlines workflows and creates a single, accessible source of patient data. Dr. Greiver began with the implementation of the practice management component for patient billing. "Billing has also become a simpler process. For instance, if a patient has to be monitored on a regular basis, I no longer have to manually bill each visit separately. Instead, I am able to keep an ongoing list of that patient's visits and bill once. All codes are pre-programmed and I'm done in three clicks."

Front-office staff uses it for scheduling and managing appointments. "Looking for available appointments has become much easier since my staff began using Nightingale On Demand. It allows them to see an entire week at a time - which they really like," says Dr. Greiver. 

After working with the practice management component for a month, the doctor moved ahead with the implementation of the electronic medical records (EMR) solution which includes clinical encounter, cumulative patient profile (CPP), prescriptions, lab reports, diagnostic imaging and correspondence.

Nightingale On Demand is web-based and accessible by all of the FHN's physicians, regardless of their location. Dr. Greiver and her colleagues are now securely accessing patient records from a portable tablet PC and enter patient information directly into electronic charts.

Results

The Nightingale solution provides Dr. Greiver and her associates with the ability to share patient data across all seven different locations. Access to records shared across multiple locations ensures that all nine physicians and their staff can provide the highest level of continuity of care to their patients.

The biggest benefits of Electronic Medical Records (EMR), according to Dr. Greiver, are the new advantages it brings.

"Consider what happens when a paper chart or test result gets misfiled or lost. In the past, when something got misfiled, it was a disaster. With EMR, we know that will never happen to us - the data is always going to be there."

 

The electronic format and security of the data also ensures that a patient's medical history will be accurate, legible and accessible, says the doctor. Patients who are dealing with a chronic disease, for example, will be able to better understand and manage their condition.

"Things that can be tracked in graphic and tabular format in the EMR over time - such as weight or blood pressure - have a significant visual impact on patients. You can't do that on paper," she notes.

Having the information stored electronically also provides benefits.

"Down the line, anyone in a patient's circle of care - whether it's the Emergency Room or a diabetes clinic - will be able to access the same comprehensive data. The data will follow the patient as opposed to the way it exists now with information silos, and each healthcare practitioner having access to only a small piece of the overall patient information. Everyone will be able to share information, much to the benefit of the patient."

Not only will patients' medical histories be accurate, but their future health will also be safeguarded. Automatic alerts will allow Dr. Greiver to ensure patients get the regular care they need when they need it, such as mammograms and pap smears.

"Automatic notifications will pop up when the patient needs an annual or monthly test, for example, and the system can even generate a letter or e-mail to the patient to remind him to schedule an appointment," Dr. Greiver says. "This is efficient and proactive care, and my patients deserve no less."

Since implementing Nightingale, Dr. Greiver has become more adept at using it to simplify her practice management tasks and improve her quality of life.

"I really believe physicians should do their own patient billing," she explains. "As billing is integrated with the clinical encounters, I now often bill as soon as I am finished with a patient. I know what I have just done, so I enter the whole billing right then and there. If there are multiple codes, I am able to do them right away so I don't forget and nothing gets lost. My patient billing has become easier and more importantly, more accurate."

Another feature that has streamlined Dr. Greiver's day is electronic lab results. By receiving lab results electronically, there is no longer a need to have a chart pulled each time results come in. The lab's server connects to the physicians' server and automatically files test results into the patient's chart. There is no human interaction required, as the filing is based on patients' Ontario Health Insurance Plan (OHIP) numbers.

"I am notified of all abnormal results, and once I have reviewed a result, I click a button and it gets filed immediately. I can also send the result to my administrator and advise her of next steps - for instance, I may require her to call a patient and have them come in," Dr. Greiver says. "The whole process is much more efficient, especially as we no longer have to pull files, and that's huge in medical practices. My administrator now uses the time she would have been pulling files to call patients on my behalf, which then saves me time."

 

Looking Ahead

While Dr. Greiver explains that the provincial funding was a big incentive for some of her colleagues to make the switch to Electronic Medical Records (EMR), Dr. Greiver notes she would have made the jump regardless. "I would have done this even without the subsidy because I believe it will improve the way I practice medicine," she says. "As more pieces of the health care system become electronic, having an EMR will eventually become the new norm."

As she uses the solution, Dr. Greiver looks anticipates the benefits her patients will gain when she decides to retire and passes along their records to her successor.

"If you're not convinced to use EMR, consider this: Who is going to take over your practice when you retire? How are you going to get new associates? How are you going to communicate with labs in the future? They are all going electronic, as are all the hospitals," Dr. Greiver says. "Now is the time to go EMR. It's a change - there's no question - and it will take time, but it will make your practice much more valuable, it will make your life easier, and it will ensure your patients continue to get care when you retire. Therefore, I would never go back to paper."

Moving to Electronic Medical Records (EMR)? Tips from a doctor who has made the switch:

1. Select a slow time of year to make the transition. Flu season, for instance, would be an inopportune time to make the switch.

2. Once you make the decision to do it, pick a day and do it and enter all information electronically, no matter how hard it is at the beginning.

3 Make the transition in two steps: Begin with Practice Management for patient billing and scheduling for the front office staff, then move to EMR for the physicians.

4 Be patient and schedule appointments lightly for the initial switch period. Expect that there will be a learning curve.

5 Call the help desk if you need assistance. Nightingale staff can save you time and frustration.