Five Question Friday: My Experience with Practice Fusion's EHR

This Week's Guest:
Chad Costley, MD

Chad in his own words:
I'm a Family Physician by training but have limited my practice to teenagers and adults. I went to medical school and completed residency at the University of Michigan and worked with two large medical centers before journeying last year into solo practice. I launched Ponce Primary Care (Decatur, Georgia) as an escape from the hamster-wheel that has become too common in primary care. With the help of Practice Fusion and other efficient IT systems I'm able to practice with a single employee and very little other overhead. I strive to provide accessible, comprehensive, evidence-based and coordinated care to my patients. In addition to my medical career, I hold a MBA from Emory University and am involved with a number of start-up technology companies. My wife, LeighAnn, and I have two boys ages 5 and 9. I'm a distance runner, tennis player and mediocre but striving cook.

Thank you Dr. Costley, for agreeing to participate in our series about electronic health records (EHRs) and their impact on health care professionals. We want an honest appraisal of our EHR, and value advice that helps us improve it. So here’s my first question:

-- When did you begin using the Practice Fusion EHR?
I began using the Practice Fusion EHR a year ago when I opened my new solo practice. I was on the verge of buying an "internet-based" version of a popular EMR for thousands of dollars when some red flags went up. I'm not overly technical, and perhaps that was an advantage when the company started talking about VPNs to connect remote computers and limits on which operating system I needed to use. The simple question of "Why can't I use this wherever I have an internet connection?" was met with really fuzzy answers.

The second and largest flag was the mandatory three-day "training" I was required to purchase. "If the system is so easy to use, why do I need to pay your consultants to sleep in a hotel here in Atlanta for three days to teach me how to use it?" I asked. Fuzzy answers.

-- So what happened then?
Fortunately, a friend who was more savvy than me found Practice Fusion through an internet search. I spent about 30 minutes trying it out with imaginary patients and documented my first patient the next day. It was great - easy to use, intuitive, unburdened by the often useless bells and whistles that plague really complex EMRs.

In my previous, large practice life, I endured the launch of an EMR project for a large health system. It was torture primarily because the system was clearly designed to support billing rather than patient care. The doctors passively and actively resisted the EMR implementation because the system didn't help them take better care of their patients. I believe Practice Fusion is different in that respect because its logic inherently follows the natural flow of a doctor-patient visit.

-- How did the first couple of days go, when you started using the Practice Fusion EHR?
Our "transition" was naturally easy as we were starting from scratch with the practice and Practice Fusion. We use it every day now for all of our medical documentation.

-- How are you using the system now?
We have a truly paperless office. FAXes arrive in .pdf format and are loaded into Practice Fusion without being printed. Any paper our patients bring in from other offices is scanned and either given back to them or shredded before I see it in electronic format within Practice Fusion. We are close to fanatical about not allowing paper to survive in our building; paper is the enemy of exceptional, well-documented, and efficient care.

We use LabCorp so do have the extra step of having to access lab results in another system and load those .pdf documents into Practice Fusion. We also don't use the calendar as everyone here operates on iPhones and needs to be able to see each other’s calendars easily when away from the practice. For example, my patients have my cell phone number. When I speak to a patient by phone I can give them an available appointment immediately via the Google calendar we all use. It would be a meaningful improvement to Practice Fusion to have it link with an outside calendar/email system such as Google (noted by interviewer; we are seeing increasing demand for this feature).

-- What’s your take on the Practice Fusion EHR? Which features do like? Dislike?
Some of this is answered above. However, I love the new e-prescribing functionality. It's so easy to use and we've had zero problems with it since its recent launch. I tend to not use templates very much as I can type quickly and find that I write more nuanced notes than templates typically allow. Having said that, I've been experimenting a bit more with the templates in Practice Fusion lately and like the ease of template creation and customization.

-- What’s missing from the Practice Fusion EHR?
The biggest missing pieces in Practice Fusion for me at this point are a secure patient communication tool within the Patient Portal and integration with LabCorp (noted by interviewer. Discussion to follow on www.ehrbloggers.com). Allowing patients access to med lists, diagnosis lists etc. is fine - but most patients don't really need that. The option of making appointments would be useful if we used the PF calendar, but we don't. What would really take the system to a new level would be the ability to communicate securely with a patient about lab results, lifestyle change check-ins, etc. directly from the system (coming soon, stay tuned!). We use LabCorp nearly exclusively so are obviously anxious for that integration.

-- How has it impacted workflow in your office?
My personal workflow has changed significantly in using Practice Fusion. I now do my documentation in front of the patient most of the time. I've never liked the approach of typing while patients are speaking - eye contact matters in primary care:) However, my patients really like it when I say at the end of the visit "I'm going to document our visit now." I literally read what I'm typing to the patient as I document. It summarizes the visit for them, leads to a clearly agreed upon plan which I often print for them. This has significantly limited the number of emails and phone calls after visits from patients who were confused about medications, referral recommendations, etc.

When I leave an exam room after a visit - my documentation is done 90% of the time. I can't imagine returning to the days of a pile of paper charts on my desk at 5:30 pm waiting for notes or the similar situation of a pile of paper "encounter forms" that need to be translated into a bulky EMR. The quality of my notes has gone way up as even a few busy hours can cloud the precise memory of exactly what happened in a visit.

-- What about support and updates from Practice Fusion?
I had a few phone interactions with Practice Fusion early on as I moved my brain away from the notion that I needed a $15,000 system :) Other than that, I've relied upon the training videos somewhat but frankly find most functions to be so intuitive that they teach themselves.

-- What advice can you give to Practice Fusion?
At the small practice level, I do think Practice Fusion needs to overcome the impression of some that if you're not charging them for use, you must be doing something shady with their patient data. I'm on a couple of list-serves where doctors have expressed this concern along these lines. "Sure it's free, but I don't really want Big Pharma having access to my patients' information. I'm not a sell-out." Being more explicit about your business model would help alleviate concerns that something that seems too good to be true usually is. (Noted. This subject is profoundly important to us. We have no right to distribute patient confidential information and we will not do that.)

This is terrific feedback, Chad. Thank you!

Interviewed by Glenn Laffel, MD, PhD
Sr. VP Clinical Affairs, Practice Fusion