Patti Bingham, CMM, practice administrator at All Children Pediatrics in Louisville, Ky., has been in the medical field for over 30 years. She’s worked in primary care, hospitals and specialty scenarios, including a start-up psychiatry practice that grew from a solo doctor to 28 providers in five locations across two states.
In a recent interview with PhysBizTech, Bingham shared her broad perspective on medicine and the practical aspects of running a contemporary practice. The transcript of that conversation follows.
PBT: What are your professional credentials?
Bingham: Well, for starters, I have a degree in educational psychology and counseling. That has come in handy wherever I’ve gone in my career. I’m a Certified Medical Manager (CMM) through the Professional Association of Health Care Office Management (PAHCOM). I also earned designation as a Certified Medical Practice Manager.
PBT: When did you come to All Children Pediatrics, and what are your primary responsibilities?
Bingham: I started in August 2000. I am responsible for general oversight of the practice in terms of operations. We have a unique situation here where the physicians all hold an office, but they leave it up to me to run everything -- the clinical areas as well as the business aspects of the practice. I have supervisors who report to me in each area, and that really helps me keep a close eye and a good handle on what’s going on in each department .
PBT: What is the office structure at your practice?
Bingham: We have five physicians and two nurse practitioners. One of the physicians and both of the NPs are certified lactation consultants. We have 26 staff members – that includes full-time and part-time.
PBT: What does your practice do especially well?
Bingham: One of the unique things about our practice is that we were early adopters of electronic health records. I have had the good fortune of working with physicians who have been very progressive when it comes to the technology.
When I came on board, they were using a very old, UNIX-based practice management system that was very inefficient, and that didn’t give a lot of good information in terms of operations. So we started searching for a new practice management system and we upgraded our hardware.
In 2002, we started looking at EHRs. That was really early on in the process. We signed on with a system and integrated it with our practice management system.
PBT: How did that turn out?
Bingham: It lasted all of six months before we had to shut it down. There was a lot of finger-pointing between hardware and software vendors. We knew it wasn’t working. It was actually inhibiting progression of our business, so we had to turn it off. And that was a very valuable – but costly -- learning experience, especially in 2001 because no one else was really doing it at the time.
When we shut it down, we decided to go back to paper records, but at some point we knew we would look for another EHR.
About three years down the road, the five physicians – all equal partners – decided we would try it again.
We spent about two years looking. At that point, we knew a lot more about what would fit best in our practice and how it would not totally turn our world upside-down. We also knew what questions to ask. But we also knew from having done it once, that we couldn’t just put the EHR in the place of a paper chart.
Your workflows, how you document, how you gather information…all that was going to change. But we wanted to minimize the effect as much as possible. I think that’s everyone’s goal when they make the leap to an EHR.
We had approximately 16,000 patient records at the time. So one of the things we had to discuss was what we would do with all that information. How would we get it into the EHR?
Eventually we found a software system. In terms of hardware, we went to a wireless scenario. We equipped our doctors and nurses with tablets.
PBT: Why did you decide to go wireless?
Bingham: First, to maximize efficiency. Previously, when a nurse took a patient back to the exam room, she would have the chart in her hand and record vital statistics on the paper chart. We determined that the nurses really needed their own computer to do that. Rather than being tethered to a desktop computer, they could do it on the fly, wherever they were working, whether that was at the way station, while doing an injection, or for documents that had to be signed by a parent. When we give vaccines, parents sign a consent form that is digitally stored on the computer.
Second, we decided not to have computers in the exam rooms. We are a pediatric practice after all, and we did not want kids playing with the computers. We have our hands full just keeping the kids away from our windows and curtains. (Laughs.)
From an efficiency standpoint, wireless made the most sense. No matter where the nurses and doctors are in the office, they can document.
The tablets are actually convertible computers. You can write on the screen or you can type on the keyboard. Initially, we had smaller devices for the nurses and more traditional laptops for the physicians. But after a while the nurses determined that the smaller units -- about the size of a netbook -- were a bit harder to read than the laptops.
When our lease came up, we decided not to renew. It’s now cheaper to buy the units outright, and we standardized on the same unit. Now every nurse has her own laptop.
PBT: Did you encounter any other practical issues regarding EHR use?
Bingham: And we also had to get appropriate information specific to pediatrics. For example, vaccine history, physical history, chronic problems, etc.
Our initial plan was to purchase in-house scanners that also had CD writers built into them. As we scanned information in, we could also copy that chart to a CD.
We decided that pertinent pieces of information such as the vaccines – things that are really important during a pediatric visit – we would scan in to the electronic chart right away. The rest of the patient information would be scanned onto the CD and retrieved as necessary.
Then we created a filing cabinet containing the CDs. We had an elaborate spreadsheet the told us exactly which patient was on which CD in which drawer so we could easily retrieve the information.
We tried to do a lot of the scanning in-house and determined after about a year and a half that we weren’t going to get it all in. There was just no way. So we ended up contracting with a medical record storage company that offered scanning. At that time, they were beta testing something new – we were the first practice to try it – and that was to set up a secure, encrypted portal with that company. They scanned our records, but we could get access to medical record information as patients came in, and we could bring that information over to our system. That’s what we ended up doing so that we could get the scanning done faster than doing it ourselves.
PBT: That was pretty advanced at the time.
Bingham: Once they got all the scanning done, they put all those charts on an external hard drive and we had a couple copies of it stored in different locations offsite as well as loaded onto our servers in-house. So the scanning process went much smoother than if we had tried to continue doing it in-house.
That was one of the lessons we learned the second time around: There are some things that make more sense to farm out to someone else than to spend the time and money and effort to do it yourself. Of course, that can be very dependent on the size of the practice. But in our case, with as many physicians and patient records as we had, that was the most appropriate solution.
In terms of adopting the technology -- the scanning and the EHR -- we were if not the first, a close second to anyone in the Louisville, Kentucky, area. And there are still a lot of pediatric practices in the area that do not have EHRs yet.
We have continued to build on that by having a patient portal. A lot of people have that now, so it’s not new news. Everybody is catching up to where we’ve been over the past four to five years.
PBT: What has this done for you on the business side?
Bingham: The process made us a lot more efficient and cost-effective. For example, we were able to divide our old chart room into two exam rooms, so now there are more revenue-generating sources for us as opposed to a place where we stored a bunch of records.
We’ve also looked at equipment that can be interfaced with our EHR, like spirometry, when we do breathing tests on children. The interface is portable; you take it in the exam room and don’t have to lug around a big piece of equipment.
We’re always looking for efficiencies where the documentation flows directly into the system as well as interfacing with labs so they go directly into the EHR.
PBT: You mentioned your CMM credential through PAHCOM. In what other ways are you involved with the organization or its membership?
Bingham: The listserv is probably the number one thing that PAHCOM offers. There is no price to put on that. It puts you in touch with so many people in so many different areas of the country. You can raise a question or ask for opinions and get responses back almost instantaneously.
There is one particular individual, Sue Zumwalt, who has always been a front-runner in this area. I have contacted her quite often, getting opinions over the years.
When I joined PAHCOM back in the 1990s, I quickly learned that by attending their conferences and using the listserv, I could stay on top of developments in the medical world, whether new technology or new testing or new healthcare laws that were coming down the pike. It’s great to be able to tap the resources of other people out there who are sitting in the same seat as me…having them available to share opinions, or to ask how to implement something. For example, when HIPAA came along, I wondered, how are we all going to do this?
The tips and tricks that people have offered through those processes have been invaluable.
PBT: Is your practice eligible for meaningful use incentive funds?
Bingham: We would meet it in every way, but we don’t have the patient population. We have all the technology to monitor all of the criteria. But being in pediatrics, we don’t take Medicare, so that takes that portion off the table. We have just applied to be Medicaid providers in the state of Kentucky, but that process is not final yet.
Had we been taking Medicaid for the last year and a half, we would have met the requirements already. We have everything else in place to do it. We already have a waiting list of patients who would like to come to our practice. We will send out letters to all those people, letting them know when our doors are open to Medicaid patients.
PBT: And what about key areas for moving forward at your practice?
Bingham: With the economy the way it is, a lot of people have insurance plans with high deductibles, and they’ve either lost jobs or are in fear of losing their jobs. So taking off of work is not an option for a lot of people. And a lot of schools really frown upon parents taking their kids out of school…leaving early or coming in late due to a doctor appointment.
In response, we have expanded our hours. We open at 7:30 a.m. Parents can bring their kids in and determine whether they need to stay home from school, and whether a parent needs to take off work. We’re now open half days on Saturdays, too. We also stay open until 8:00 p.m. four nights a week.
The expanded hours been so well-received. People thank us because they don’t have to take their kids out of school or take off work.
The next step for us is to become more involved in social media. Being in pediatrics, most parents are a lot younger than some of us who are working here. And the times have changed on how they communicate. We are putting together a plan so that we can better communicate and educate our patients through Twitter, Facebook, Angie’s List. We feel the communication piece is key to educating the parents of our patients.
We’re also creating a pediatrics blog so that our patients can get more information about any pediatric issue. For instance, we like to let people know every year when the list comes out with the new car seats approved by the government. So if parents want to know the safest car seat to get for their kids, we can tell them.
You’ve got to roll with the times. We want to be part of how people communicate these days.
PBT: Sounds like an exciting future. Thanks for sharing your thoughts and experiences with us, Patti.
This interview was arranged through PAHCOM. Click here for more information about PAHCOM membership.