Is a DIY EMR right for your practice?
Lloyd Hey, MD
For physicians with an eye on quality control and a mind toward specificity, building your own EMR would seem a perfect fit.
Not only does documentation get tailored to the precise needs of a practice’s workforce within such an EMR, but the shaping of the system falls to the physicians and office personnel themselves. In other words, those who know their practice best get to design it for success, according to Lloyd Hey, MD, a practitioner for the Hey Clinic for Scoliosis and Spine Surgery in Raleigh, N.C.
For Hey — whose clinic employed do-it yourself (DIY) software FileMaker (a division of Apple) to develop its EMR solution known as Aqueduct — being able to design the conveyor belt that sustains this natural information flow has proven invaluable. But just like Rome, Aqueduct wasn’t built in a day and it takes a certain type of practice and practitioner to keep it thriving.
Medical Practice Insider Associate Editor Madelyn Kearns recently spoke with Hey about the challenges and essences behind the do-it-yourself EMR, a phenomenon that continues to pique physician interest nationwide as compliance pressures heat up.
Q: What initially appealed to you about the DIY approach to electronic medical records?
A: I couldn’t find a system out there that did everything I wanted. When I actually tried to use an EMR vendor and then use a billing vendor, even though they both promised me "these things will work together," it turned out that they didn’t. And the big picture that I’ve been striving for is continuous quality improvement. Basically, I wanted the system to improve as we learn and when you buy something off the shelf, it’s sort of like buying a brick — it is what it is. You can submit a request for a change but it may take years for them to fill it, whereas if we build it ourselves, we can tweak it and keep making it better every week.
Q: What was your primary focus in building Aqueduct?
A: In any organization, especially in healthcare, there’s a natural flow of information that needs to happen. It starts when patients find us on the web and send an appointment request or ask a question. And that turns into an appointment being assigned and then the actual arrival. Once data moves along from one step to another, we constantly refine the error-checking to make sure we get the data in right the first time.
Q: For what type of practice do you think DIY EMR is a good fit?
A: What you have to think about is whether the EMR can help your practice work more efficiently and compete better because your quality is going to be much higher. Quality is an important factor in attracting patients and insurance companies. You should also consider whether you really want to do constant quality improvement — if an error occurs in your practice one week, would you like to be able to have that fixed so it never happens again? We do absolutely everything on our FileMaker Aqueduct system, including printing up consent forms, and you never have to put information in twice and you never have to write anything out. Rather than having to adapt to your system, why not have your system optimized to adapt to you and your practice?
Q: What recommendations would you give to practices that implement a DIY system?
A: I strongly suggest physicians have a weekly quality meeting with their staff where they go over patient care issues, quality issues and then errors that come up. Get all employees and all associates involved in the process because everybody can contribute. Each of the people on my team can leverage their own creativity and learning and actually see the fruit of that come out with a better system. Everybody feels like we’re in a practice that’s always moving forward, that’s always improving, and we stop the mistakes from happening next time. It gives me great confidence at the end of that quality meeting to know that those new changes are going to take effect not in three years, but next week.
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