Physicians at urgent care clinic implement ‘hybrid’ EHR

Dr. Thomas Pascuzzi attends a young patient at MD Urgent Care.

When Thomas Pascuzzi, M.D. opened his first MD Urgent Care clinic in 2008 in Albuquerque, N.M., he sought a fast and easy way for him and his six full-time physicians to document, access and archive patient encounters electronically. But like many ambulatory care practices operating on tight budgets, getting onboard the technology bandwagon was financially out of the question. Nonetheless, this all-too-familiar conundrum quickly turned into opportunity.

Pascuzzi conceived the unique idea of a “hybrid EHR” that leveraged two existing systems at his two MD Urgent Care clinics: a paper-based emergency department medical record template and an online documentation management system.

Pascuzzi had been using T-System, Inc.’s paper templates, T Sheets, in various practice settings since the late 1990s after completing his specialty training in emergency medicine at the U.S. Joint Military Medical Centers in San Antonio, Texas. His positive experience led him to create a new workflow process that would put the paper records onto the MD Urgent Care providers’ desktops, iPhones and iPads.

Here’s how it works: A patient episode is charted to paper. Once the visit ends, a staff member immediately scans and uploads the record to an online documentation management solution. After the record is uploaded, it can be archived, retrieved by simple search, faxed or electronically edited via the addition of scanned pages or notes. In all, staff members scan approximately 7 to 8 sheets per patient in less than a minute, equating to more than 300 pages of patient records made available electronically and ready for internal or remote viewing by end of day.

“If a patient’s lab results are returned after I’ve already left the clinic for the day, I can review them on my phone, along with the rest of the chart, while I’m on the go or from the comfort of my home,” Pascuzzi explained. “This allows me to keep tabs on my patients no matter what the location.”

Before implementing the documentation and online storage process at his clinics, Pascuzzi carefully evaluated the cost factor and security of the documents. In terms of expenses, MD Urgent Care’s costs encompass printing paper templates, scanners and templates as well as documentation management subscriptions. When Pascuzzi’s clinics first opened, the practices were small enough that it did not make financial sense to implement an electronic record system. Pascuzzi said he will soon re-evaluate using an EHR as his clinics expand and the costs of paper and electronic documentation management rise. 

To protect document security, Pascuzzi ensured that the online solution supports HIPAA compliance. The system uses encryption, secure passwords and access tracking actions to achieve HIPAA requirements and mitigate security risks. It also enables the clinic to organize users into groups, with each assigned unique log-on authorization rights.

“Our system uses a reliable documentation method and readily available documentation management technology, allowing our providers to chart quickly and effectively while also making secure records easily accessible at any time,” Pascuzzi noted. “It’s a simple process, and it’s a process that works.”


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