Surgeon Runs Practice with Self-Designed EMR
Vol. 1, Issue 1 - April 10, 2008
James Ochi, MD was fed up with his costly pediatric ear, nose, and throat surgical practice. Ten years ago, Ochi was paying a growing office staff to manage the mountain of paper medical records he was creating. He had to see 40 or more patients a day to cover those costs and to make a living for himself. The Encinitas, Calif. physician decided it was time for a change.
“When I was running a high volume practice, it was overwhelming, and I knew my patients were not happy,” Ochi told us.
EMRs Too Expensive, so Physician Built His Own
Ochi shopped around for an electronic medical records system. While he liked some of the features he saw, he found commercial systems too complicated and too expensive for his needs. He decided to develop his own system to simplify his practice.
Ochi began storing patient information on his laptop using Microsoft Word, voice recognition software, and a document management system. He created a simple Web-based scheduling system that allows patients to set up their own appointments with him.
Simple Changes Support Micro Practice Trend
Those simple changes had a substantial impact, allowing Ochi to go solo – literally. His streamlined system allows him to run a practice that requires no other employees. He performs their former tasks himself.
Ochi makes about a third of the income of his peers, but says he has modest needs and enjoys his newfound independence and peace of mind. Having more free time allows him to travel abroad on medical missions to help the poor.
Ochi is an example of the trend of micro practices, also known as patient-centered practices. They use high levels of technology, few employees, and low overhead to strip away barriers between doctor and patient and to give frazzled physicians a renewed enthusiasm for practicing medicine.
Micro practices are springing up because both physicians and patients have become dissatisfied with the way medical practices are run, Ochi says.
There’s a lot of frustration among physicians right now. I think the truth is, if someone told them they could have a shorter workday and better relationships with their patients but would make less money, many would still say no,” Ochi says. “However, there are a growing number of doctors that are starting to think this is a great idea.”
Patients Like Online Scheduling
Ochi credits the Web-based scheduling system with having the most impact on his practice. He says it has significantly increased his office’s efficiency and reduced patient wait times.
Patients choose an available appointment time slot from Ochi’s Web site. The system provides registration and medical history forms that patients print, fill out, and bring along for their appointment.
The first version required patients to register with a user name and password to address Ochi’s concern about prank appointments or patients who might schedule time but not show up. However, patients found the process arduous and weren’t using it.
The registration barriers were removed allowing patients to schedule in just a few seconds. Usage picked up. “Believe it or not, I have only had one prank appointment in the years since I started using the online system,” Ochi says. “It’s been very successful and the patients love it.”
Waiting Room is Empty
The biggest advantage Ochi sees with online scheduling is getting rid of the downtime when patients arrive. Until recently, his patients arrived at an empty office while Ochi finished up with the previous patient in his exam room. They signaled Ochi to their arrival by turning a light on and off.
Now, Ochi shares an office and receptionist with a colleague. When patients arrive, the receptionist presses a button that vibrates a walkie-talkie in Ochi’s pocket, letting him know his next patient is ready.
“Normally, physicians don’t see patients until 15 to 30 minutes after their scheduled appointment time, which makes the whole day run late,” Ochi explains. “With this system, no one should ever be waiting. I schedule a half hour for new patients and 15 minutes for a follow-up. Everyone usually goes right in when they arrive.”
Information Stored on Flash Drives
Ochi takes notes by hand in the exam room. This was a conscientious decision. He believes patients don’t think doctors are listening to them if they’re typing during the visit.
Several times a day, Ochi dictates his notes into his laptop using Dragon NaturallySpeaking, a speech recognition system from Burlington, Mass. based Nuance Communications, Inc.
Nuance also provides Ochi with his PaperPort scanning and document management system. He uploads lab results and other patient records to several encrypted and password-protected flash drives. “There is about three gigabytes of information on those flash drives. That’s all of the information from every patient I’ve ever laid eyes on,” Ochi says.
Ochi’s office has no file cabinets. Even business information such as leases and managed care documents are scanned and stored on the flash drives.
System Lacks Capabilities, but is Ideal for Solo Practitioners
Ochi says his system works well for his practice, but admits that larger entities wouldn’t find it practical. He can send records to another physician if the patient gives consent, but it lacks the specific interoperability capabilities of modern EMR systems.
For a solo doctor, though, Ochi says the system is ideal because it’s cheap, efficient, and, most importantly, it puts patient information back in the hands of the physician. When Ochi speaks at medical schools, societies, and in physicians’ offices, he stresses that this could be a time for the rebirth of the solo practice through the use of information technology.
“Primarily, it all revolves around overhead, and doctors are wary of running a solo practice because they don’t want the overhead to consume them,” Ochi says. “I do more secretarial work than the average physician would ever tolerate and I’ve lost income, but changing my practice has given me and my patients so many other advantages.”
— Correspondent Maureen McKinney