HomeWhat's NewStories of ChangeDr. James J. Meyer - Littleton, CO

Stories of Change :
Implementing Medfusion in a Solo Practice

by James J. Meyer, MD - Littleton, Colorado

I have a relatively new solo practice in Littleton, Colorado.  I started offering e-Visits almost from the start, using a product called Reach My Doctor, before I even came on board with the TransforMED demonstration project.  I have since transitioned to Medfusion for secure, HIPAA-compliant, web-based communications and transactions with my patients.

My practice offers patient pre-registration, e-Visits – or Virtual Office Visits (VOV) as Medfusion calls them – as well as bill payment with a payment plan option. I also use the virtual card swipe to process all credit card transactions via the Web. That's really helpful because I avoid the need for an analog modem.

I would like to offer online lab results reporting, but I haven't made the decision to use Medfusion. Their online lab results process is proven. And they're really good about tracking patient follow-through. You can do a quick report to identify unread communications. That's critical when it comes to giving patients lab results online. But I am waiting for my electronic medical record (e-MDs) to come out with a new version that will include a patient portal feature which will integrate online lab results for both the practice and patients. Having lab results integrated with my e-MDs electronic medical record is the ideal solution in my opinion, as it reduces steps between me and the patient. e-MDs is still working out the kinks, though, so we’ll soon see the quality and functionality of the finished Patient Portal product.

I considered using Medfusion's Web site templates but I already had a Web site that's very professional, polished and search-engine optimized.  And I had received so many positive comments about it-- people like my Web site and say it's easy to use. So I decided to keep my existing Web site and augment with the features Medfusion has to offer.

As for online prescription renewals— I don't offer them. I am of the opinion that prescriptions authorizations are best renewed through the patient’s preferred pharmacy. This policy reduces errors and is a patient-care practice that increases safety and accountability.

VOVs are great for straightforward diagnoses such as UTI's. And, the structured intake system is quite versatile. The provider can choose whether to use the built-in chief complaint templates, which are pretty good, or customize them. Or even to override them and allow patients to simply enter their own freeform text. Obviously, e-Visits aren't for everyone, you do still need to keep redundant systems in place. But they're particularly good for a certain type of patient— people who work at computers or people on the go who do a lot of text messaging on portable devices like  a cell phone or a BlackBerry, that sort of thing.

e-Visits also have the potential to demonstrate significant improvements in outcomes for patients with chronic conditions— blood pressure follow-up, diabetes, asthma. I can see that there's a real potential for synergy between chronic disease management software applications and web-based virtual office visits, especially if you customize the structured intake templates for your practice's needs. Factor in the convenience and the low cost— patients don't have to come into the office and it's about the price of a co-pay— and that seems to me to be a win-win solution.

Some of the secure patient portal vendors use a subscription model, where the patient pays a monthly fee. But if patients don't have any medical issues and thus don't use the service during some months, they might feel like it's a waste of money. I find that I'm much more comfortable with the reimbursement model for Medfusion's VOVs, which can perhaps best be described as "a la carte."  It's generally fee-for-service, but also very flexible— the practice can set the fee, charge different fees, or even waive fees. The provider controls the charges, which are set at the end of the VOV. That's very important. For instance, if a patient initiates a VOV and in the course of the e-Visit consultation I decide that she needs to come into the office instead, I can communicate that to her and waive the fee, since she will pay for the office visit. Because my goal in offering e-Visits isn't to charge patients for "extras", but rather to provide care in venues that give patients access.

I try to be informed and agile in my technology decisions. I'm one of those younger generation technophiles-- what you might call the Nintendo generation. Office-based technology is one of my soapbox issues. I actually like this stuff! So I'm always comparing and contrasting products and resources, cherry-picking, trying things and seeing what works for my practice. I'd prefer to have as many features as possible integrated with my EMR-- with which I am very satisfied— but I try to be flexible and go with what works for me and my purposes.

I know that some doctors feel overwhelmed and disconcerted by these new technologies. But in my opinion it's not really the technologies that are problematic as much as it is the mindset of some physicians. Yes, you've got to have some basic infrastructure— a fast and reliable internet connection, secure computers, perhaps a dedicated workstation, that sort of thing— but that's not the real issue. Those problems are easily solved. The real issue is attitude and being open to new ideas and new ways of doing things. If you find yourself unrealistically resistant to implementing electronic health records in you’re practice, you simply MUST change your mind (which is admittedly not simple at all)— or resign yourself to most likely being miserable for the rest of your professional medical career. Because it WILL happen (actually, it IS happening now)— with or without your consent or cooperation.

I encourage family physicians to make that mental leap, make the commitment and then work on it incrementally. Investigate. Compare features. Visit a practice that's using the technology. Get your infrastructure in place. Demo different EMRs. Do a trial run. You have to step up, get started, educate yourself and be plugged in. Family physicians, and physicians in general, simply must catch up with the rest of American professionals in utilizing readily-available and affordable technologies in their practices. I have yet to hear any convincing argument to the contrary.