Electronic records player

Portland Business Journal
by Robin J. Moody
Business Journal staff writer
http://portland.bizjournals.com

Installing an electronic record system at a medical practice turns every work process upside down, and leaves staff dazed and disoriented.

The Robertson Group of Lake Oswego helps small and midsize clinics navigate the process and choose from a dizzying array of 400 vendors available nationally. The three-year-old business has more than $1 million in sales, and has doubled revenue in each of the first two years of operation.

Dr. Harry Rinehart, a family practice physician who runs a nonprofit clinic in the coastal community of Wheeler, previously spent $65,000 on a failed electronic medical records implementation, but is moving forward on another try with Robertson’s guidance.

“We would not have been able to proceed without having someone like Nan [Robertson] to hold our hand through the process,” said Rinehart.

Company founder Nan Robertson has found herself in the enviable position of turning down work because she’s so busy. Seventy percent of Oregon’s medical practices have nine or fewer physicians and many are scrambling to join the digital age.

Robertson has tabbed a half-dozen semi-retired contract workers with clinical IT expertise to help on the job. The Robertson Group has consulted with 120 clinics, many through independent physician associations, and typically juggles 10 to 12 clients at one time.

The company helps clinic leaders clarify goals for an electronic medical record system, select a vendor, plan and implement a system, and optimize and expand the system once it’s installed.

Robertson also wants to ensure the sharing of health data in communities. That means primary care doctors can electronically send patient information to hospitals, nursing homes or specialist physicians with patient permission.

Robertson encourages clinics she works with to band together to get cheaper group purchasing rates and to distribute maintenance costs. The company also targets independent physicians associations, groups of independent-practice doctors who join together for various business reasons. The Robertson Group does not align itself with any single vendor, but tends to choose from among a group of seven.

“There are a lot of vendors out there with crummy products,” Robertson said.

The company also advises physician practices on how to outfit exam rooms with computers to maximize the patient experience, and coaches doctors on patient-communication styles following electronic medical record adoption. This business has taken Robertson all over the country to speak with clients, and has prompted her to step outside her small-clinic niche. It currently comprises 10 percent of the company’s business, but Robertson predicts it could grow to half within two years. The greatest interest in this service has come from large health systems in the Midwest and East Coast, she said.

Acumentra Health, Oregon’s health care quality organization for Medicaid and Medicare, has contracted with The Robertson Group to assist 42 small clinics around Oregon to launch electronic medical records under the DOQ-IT project, sponsored by the federal Centers for Medicare and Medicaid Service.

A pharmacist by training, Robertson started the business after she was laid off by Kaiser Permanente after 31 years of working there. In her latter years at Kaiser she focused largely on clinical technology projects and has parlayed that knowledge into her business.

Several trends are creating new urgency for medical practices to adopt electronic records, including new Medicare rules requiring physicians to report quality measures to earn a raise, and insurance plans and employers moving toward pay-for-performance, in which providers are rewarded for good outcomes.

The United States well lags behind other developed nations in adoption of electronic medical records, with between 14 percent and 20 percent of medical practices wired, according to various studies. That number is likely higher in Oregon, though. An estimated 59 percent of physicians have adopted or are implementing electronic medical records, according to a survey of 1,769 physicians conducted by the Office of Oregon Health Policy and Research in 2006.

With an average purchase and implementation cost of roughly $35,000 per full-time physician, and maintenance costs of around $1,000 per month, medical practices cite shortage of cash to invest in electronic medical records as the top adoption obstacle. Across the board, primary care practices have watched income decline over the past decade, according to the nonprofit Center for Studying Health System Change in Washington, D.C.

There’s also a fear factor.

“There are doctors out there who say, ‘I hope I’m retired by the time we implement … electronic medical records,” said Doug Ritchie, vice president of medical informatics for Central Oregon Electronic Medical Records, a subsidiary of the Central Oregon Independent Practice Association.

Robertson said the biggest payoff from implementation of electronic medical records doesn’t come in a direct return on cash investment, and it probably won’t result in more patients being seen.

“It’s a wash for the doctors,” Robertson said. “The productivity value is in efficiency gains for support staff and access to the medical chart at all times.”

The electronic systems also prepare physician practices for the likelihood that they will soon have to demonstrate positive patient outcomes to get paid.

Robertson’s company has partnered with Peer Technologies LLC to help practices choose technology and purchase equipment.
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