One of our judges, David Albenberg, MD, calls FMST the "mack daddy" of tech-savvy practices, and says he was knocked over by both its technological innovation and its empowerment of employees; but he adds, "What really got me with this practice was their focus on doctor-patient communication. These guys have it going on — video patient education, Web site portals for access to patient records, e-mail access to physicians, and e-newsletters all establish, build, and solidify the doctor-patient relationship."

FMST's physicians also got more than style points for thriving with a flat organizational structure that does not include a practice manager. Our physician judges in particular were impressed by the personal involvement of the physicians in practice operations. That involvement is so intense that it makes a manager seem superfluous.

Judge Juliet Breeze, MD, argues that because FMST is "truly physician-managed," it "combines the pursuit of clinical excellence and outstanding patient care with the ideals of a highly efficient and effective workplace." She adds that the physicians' "creativity, innovation, and eye toward efficiency appear to have created dramatic results for their staff, themselves, and most important, the patients."

What puts Family Medical Specialists of Texas a cut above the rest? Three very big factors:

• Its innovative and aggressive use of technology. Gothard, Crow, and Weyenberg are technologically savvy but not gadget junkies. They simply recognize that wise use of technological tools can achieve three outcomes: It can make their lives simpler, giving them more time with patients; it can make their office more efficient; and it can harness data on hundreds of patients to allow them to easily examine clinical trends and outcomes.
  
  
• Its insistence on an organizational culture that makes everyone personally responsible for overall patient experience, and thus for the group's success.
  
  
• Its successful linkage of patient care to office efficiency, employee and physician satisfaction, and financial success for the practice.

Tech talk

FMST's embrace-change philosophy's clearest manifestation is in its EMR usage. The group doesn't simply have an EMR; it exploits the technology (and others) to every advantage, from clinical reporting to chart-keeping, coding, billing — you name it.

FMST estimates it spent more than $100,000 on its GE Healthcare Centricity practice management and EMR systems, but the group says it got its investment back in about 18 months. The practice credits the technology with boosting each physician's income by as much as $80,000 a year, through a combination of improved overall efficiency, more accurate coding, and an increase in the services they provide. The EMR alerts doctors and staff to services patients need but haven't received. It's a happy coincidence that providing better patient care tends to be more lucrative to physicians.

Staff rave about the EMR. "I love it," says nurse Dawn Sanchez. "At first, I was a little intimidated, but now — oh, it's so much easier." Sanchez, a four-year veteran of the practice, began working there when it was still using paper charts. She had previously worked at other paper-based clinics. But she hopes she never will again.

"The biggest thing [pre-EMR] was taking a phone call," Sanchez recalls. "We'd have to go hunt the chart down to talk the patient. Sometimes the doctors would have it in their office when we needed it."

Patients like it, too. Brendan, a 30-year-old entrepreneur who was in the office for a physical, told me, "I'm a newbie at this practice, but so far I'm very impressed. It's the most technologically advanced doctor's office I've ever been to."

The technology also allows the doctors to examine their patients' clinical trends, comparing them with national averages through its participation in GE's Medical Quality Improvement Consortium (MQIC). Each night, through MQIC, de-identified patient clinical information is uploaded to a central repository housed by GE, which then aggregates the practice's data. The doctors can go online to see how their practice compares with other practices around the country on protocols recommended by the National Committee for Quality Assurance (NCQA).

Weyenberg, the practice's tech guru, shows me the comparison, which is displayed in a form clear enough for anyone — even a magazine editor — to understand.

The data enables to physicians to see the extent to which they are following protocols in the management of chronic diseases. One such disease of particular interest to FMST's physicians is diabetes, and its doctors were alarmed to discover at one point that only about 31 percent of their diabetic patients were getting their recommended eye examinations. That's below the 50 percent national average, and well below NCQA's 60 percent target. Weyenberg noticed this and sounded the alarm.

"We were at 31 percent, and thought, 'This is crazy,'" Crow recalls. "Now we're over 60 percent. But 60 percent is not acceptable to us."