There are 16 patients scheduled today for hearing evaluations. Each appointment is scheduled for 45 minutes. The first patient's evaluation begins at 8 a.m. At 8:50 a.m., her internist receives a copy of her audiogram, immittance studies, and audiology consult note. At 9 a.m., she is checked in on the next floor to follow up with her neuro-otologist regarding the perforated tympanic membrane in her left ear. The neuro-otologist is able to open the chart, review her history and physical exam, and see all the results from the audiology appointment just 15 minutes earlier.
This is a typical day at the Washington Audiology & Imaging Center, a new division of the Washington ENT Group in Washington, DC, the first fully digital practice of its kind. Gone are the days of missing charts and lab reports. In the paperless office, all patient records are kept electronically, and all office functions are performed digitally. Clinicians are able to review a patient's medication, history, and current complaints before, during, and after the evaluation for better treatment and diagnosis.
In today's health care marketplace, clinicians have less time to spend with patients because of increased paperwork, billing, and insurance forms. The primary goal in creating a digital office was to put the staff and patients back together again. Technology provided an infrastructure that would:
- optimize the quality of the patient encounter
- improve support infrastructure for physicians
- design a functional office to support new practices and processes
- eliminate inefficiencies of post-encounter maintenance of the patient
- retain a customer focus and increase quality of medical decision-making
The technology significantly increased time for patient care—but creating a paperless office is not for the faint of heart. The most difficult hurdle for the office was aligning the staff to fully utilize the computerized system. There are no more sticky notes around the office or tablets of scratch paper where quick notes were once made during an office visit. Another challenge was getting used to images instead of paper text. As new patients come to the practice—along with their paper medical records—the most labor-intensive task has been converting the paper records to digital records and then shredding the paper. Audiograms from previous evaluations performed at other centers are received by fax within the computer system and immediately attached to the patient record.
The audiologists use computers called Clios, which are similar to a small laptop computer and have a wireless transmitter that works like an antenna. This allows patient information that has been entered into the electronic medical record to be transmitted into the main file database. Audiologists can enter information into the record while standing in a sound booth with a patient. At the end of the evaluation, the audiologist can complete their chart entry by using the Clio or a desktop computer at various kiosks throughout the office.
The practice utilizes an operating system designed by A4 Health Systems. When the practice was originally created, the company spent time with staff designing a medical record system to meet the specific needs of the practice. A4 Health Systems continues to provide follow-up training every six months to help staff tailor the operating systems.
The security with this system is amazing. Protective systems include firewalls, virus detection, and protection against hackers. For security and confidentiality, each employee must use a password to log into the system, and they are only given access to information that is relevant to their daily work. Procedural guidelines and policies are in place for each electronic application. Prior to opening this practice, extensive research was performed to guarantee patient confidentiality and adherence to the upcoming requirements of the Health Insurance Portability and Accountability Act.
Significant thought must be put into information systems design, since many databases that house critical information must be separate and protected. Another consideration is creating the interface between the many test systems that must communicate successfully. For example, the Aurical test system used to perform hearing evaluations and program hearing aids requires software and computer languages that are different from our middle ear analyzer. To complicate matters, our operating systems need to integrate into our electronic medical records, which use an operating system and language of their own. But once the design and operational issues were addressed, the system has been error-free for more than a year.
A particular success story was the integration of the Audiology & Imaging Center testing into the overall electronic medical records and digital practice management systems of the group's practice. Although some small "work-arounds" still linger, such as manual scanning of middle ear results, the overall platform runs well. The biggest success has been the reduction in time spent looking for patient charts and lab results and dictating chart notes.
The digital platform has doubled the efficiency over the "standard" practice, allowing the practitioners to spend the majority of their time focusing on patient care. The patients are pleased with the time they have with their audiologist and are relieved to find that most of their physicians receive consult notes and test results within the same day—if not the same hour—they were evaluated.