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Small-Town Doctor, Big-Time Technology


Stories from the trenches: A story about how Wendy Smith implemented an EMR for her practice, making the transition to a paperless charting system.

Wendy Smith's otolaryngology practice is nestled in the backwoods of north Georgia, along the edge of the Great Smoky Mountains, surrounded by tiny towns in Tennessee and North Carolina. She's the only full-time ENT in a 50-mile radius. When she appeared before the local hospital board to discuss a financial arrangement, she dressed in a suit, only to face men wearing overalls.

But don't think for a moment that there's anything backward about the way Smith practices medicine. Despite her location and solo status, she uses all the advanced information technology systems and devices she needs -- from an EMR to laptop computers with touch screens, wireless Internet access, and a RAID (redundant array of independent discs) 10 server that allows recovery of data if one of the drives crashes.

"I carry my entire office of electronic charts in a 12-by-12-inch laptop to the hospital when I do surgery or consults," she says. "We're not just leading edge, we're bleeding edge."

After she completed her residency four years ago, Smith practiced in North Carolina for a year before moving to Blairsville, Ga. (pop. 659), where the remoteness was a draw, not a deterrent. "I was looking for an area that was in need of an ENT, rather than elbowing my way into a crowded suburban area," says Smith. Nor did she want to compromise her desire for IT. She found she could do it all in tiny Blairsville.

Once Smith had her practice management system up and running smoothly (she purchased it in 2002), she decided it was time to implement an EMR. Her goal was to make the transition to a paperless charting system before her practice grew too large, and she advises other paper-dependent physicians not to put off the move to EMR: "They're like cell phones were five years ago. You just have to get used to them," she says.


For help, she turned to Richard Johnson of Blue Ridge Data Systems, whom she'd been using to back up her computers. Smith, like many solo or small-practice physicians, doesn't have the luxury of an in-house IT staff, and she recommends asking folks who provide backup services if they also offer consulting and tech support. She couldn't survive without it.

Smith knew she needed an EMR that would allow her to electronically transfer as much patient data from her practice management system to the EMR, and she wanted the two to work well together. Johnson recommended, and Smith ultimately chose, MediNotes Charting Plus.

Smith had found the training offered by her practice management system vendor to be inadequate -- it didn't go beyond the basics. So when she purchased the EMR, she went to the "mother ship" -- calling on the product manufacturer, rather than the vendor, for training and support. The office went live with the EMR in March 2004. As of that date, all new patients (about 12 a day) were given electronic charts. Now about 75 percent of her patients have electronic records.

In conjunction with her move to an EMR, Smith spent $30,000 on hardware, including three laptops and one desktop computer, six monitors, three scanners, and four printers; she also spent about $18,000 in software, including Microsoft Office and the ChartingPlus system. "The cost of IT support -- labor hours, panic calls, etc. -- was

$19,000 for the first year," she says. Smith now spends about $500 per month for IT support -- far less than the cost of a full-time employee.


Smith is a big fan of her EMR, which she says has streamlined her documentation and made her charts more complete.

"I can fax the referring doctor the note I wrote on her patient the same day I saw the patient," Smith says. "I can retrieve hospital lab data online and get it into the EMR patient chart the same day.''

There's no more transcription and no more handwritten patient instructions. "When I am done with a patient, my notes are written ... patient instruction sheets are printed out, prescriptions are printed out, and so is the entire bill, including accurate ICD-9 and CPT coding with modifiers gleaned from data in the EMR note," she adds. "When I walk out the [exam room] door, I never have to look at the record again until the patient's next visit."

She also likes the fact that her EMR system is constantly updated and upgraded. MediNotes sends regular bulletins with information on new features, seeks input from users about problems, and solicits their ideas for improvements -- one of which came straight from Smith. The company recently added the capability of putting nicknames into the EMR.

"My patient's nickname might be Bubba, but in the medical record it says his first name is James," she says. "When he wakes up from surgery I am not going to call him James, because that will not help bring him back to reality. I need to be able to retrieve his nickname from the EMR -- and now I can."

This article originally appeared in the September 2005 issue of Physicians Practice.

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