Software Improves Student Health Services

• By Tomas A. Mackey
• 08/01/02

As director of the student health center at University of Texas (UT) Health Services in Houston, it is one of my jobs to ensure that students receive high-quality medical care. Several years ago, my staff and I concluded that the best way to provide high-quality healthcare to our students was to stop using paper charts and to start using electronic charts, also known as electronic medical records (EMR).

At the time, the use of EMR was almost unheard of for student health centers; now it is slowly gaining recognition as the most efficient, effective and secure medium for storing patient information. Since we implemented EMR, we have saved money, improved our knowledge of our patient population and even increased our revenue by seeing an additional five to eight patients each day.

Founded in 1991, UT Health Services is an ambulatory care clinic that serves students from three neighboring universities: Texas Woman’s University, Prairie View A&M College of Nursing and the University of Texas Heath Science Center at Houston. We see approximately 12,000 patients annually. After about five years of operation, we decided to look at EMR systems in order to eliminate some of the following problems: an inefficient infrastructure, an inability to collect data on our patient population and an overwhelming amount of rarely used paper charts.

- Our infrastructure was not efficient. A paper chart could only be in one location at one time and, when different providers needed to see it, someone had to physically carry it around. Many staff members were dedicated to finding, transporting and refiling paper charts. Not only was that an inefficient use of personnel, but it also slowed the speed at which we conducted business. When a patient calls, I need to see his or her chart immediately to respond to the situation.

- Using paper charts prevented us from collecting data on our patient population. It was frustrating not immediately being able to tell how many hypertensive patients we had or how many patients were on a certain medication. In addition, we could not track our students’ immunizations to make sure they were current. We simply had no way to measure in a reasonable timeframe the quality of care we were providing.

- Storing paper charts for our transient patient population put heavy demands on our storage capacity. In Texas, we are required to keep charts for seven years. We had thousands of charts for students who had graduated. We rarely needed to access those charts, and they were taking up a fair amount of space in our office.

These problems were severe enough that we were forced to find a solution: select and implement EMR. We formed a committee of five staff members and went through the process of researching and evaluating different systems. In addition to EMR, we also wanted a scheduling application and a billing application. We decided we wanted an integrated system rather than trying to integrate different systems on our own. After six months of evaluating different products, we purchased the Practice Partner suite by Physician Micro Systems, Inc., of Seattle. Their system won our approval because it is one of the few well-integrated systems -- it is geared toward primary care, is flexible and adapts to the individual needs of each provider.

The implementation process went well despite our staff’s lack of computer literacy. Before the software was installed, our receptionists never used computers. After two days of system training, the staff started using the system. Within one week they felt comfortable with it.

The transition from paper charts to the computer system was surprisingly quick. As patients came in, we would summarize their paper charts on the computer. After two or three visits by a patient, we stopped using that patient’s paper chart altogether.

The efficiencies of EMR have surpassed our expectations. We have nearly eliminated all paper through the office. Laboratory and radiology results come into Practice Partner electronically through an interface. The application contains an electronic messaging system that allows immediate interoffice communication without the use of sticky notes. All of this translates into enormous time savings for staff.

Our infrastructure is more efficient because we have immediate access to patient charts from any computer in the office. We were able to reduce our staffing by one receptionist and one clerk, which saves us around $30,000 each year. We have saved a considerable amount of money on space, personnel and paper.

The quality of care our patients receive has improved dramatically. Providers are able to access patient information the second it is needed and can respond to patients faster. Some of our providers even access the system when needed from a home computer with a modem.

We conduct research on our patient population. We run reports that tell us which patients are overdue for a specific test or exam (like a pap smear) and then send letters to remind them to make an appointment. We can run virtually any type of query on the database, finding anything from the number of patients with diabetes to a list of patients taking Coumadin. We can also run reports on immunizations to find patients who are due for their second MMR shot or third hepatitis B shot so that they can be called into the clinic.

Our patients are better educated. Practice Partner contains a collection of handouts addressing more than 4,000 medical conditions. During an exam, our providers can easily print out the relevant handout and give it to the patient. We can also graph longitudinal laboratory test results on the computer for patients and providers to see.

New providers receive a 45-minute training session and then a self-paced tutorial for 30 minutes. After that, they can use the application when seeing patients. The ease of learning the application has been an enormous benefit.

Our patients have been impressed. One of my patients said that he wished his other providers had EMR because they frequently misplace his chart. As part of an institution of higher learning, I am glad our patients perceive our clinic as more efficient and progressive.