In the past, Dr. Caren Campbell of Bay Area-based Caren Campbell MD Dermatology had worked for practices that used a variety of electronic health records.

THE PROBLEM

But none of these EHRs offered online scheduling or online check-in (pre-visit paperwork) for patients prior to arrival – or if they did, they were incredibly expensive. When Campbell was opening her new practice, she shopped around for an EHR that could help keep staffing to a minimum and administrative burden low.

PROPOSAL

She decided on the cloud-based EHR developed by vendor DrChrono.

"They offer online scheduling, online check-in and a patient portal that is user-friendly. And the EHR can be used on a desktop, phone or tablet," Campbell explained. "It is at an affordable price point, and the customer service team is responsive. I could create a seamless experience for patients by integrating the scheduling links within my website and have them see a branded booking site."

Online scheduling cuts down on administrative burden for the office. The practice is able to increase the number of patients and appointments without having to have staff answer and set appointments for patients, she added.

"There also are appointment reminders and a patient portal that allows for patients to follow up and see what appointments they have coming up so we reduce no-shows," she noted. "Additionally, check-in capabilities allow patients to check-in at their convenience, making it a more pleasant experience for them."

She worked for other practices where she saw more than 40 patients per day, which was not how she personally wanted to practice medicine. She wanted to spend more time with fewer patients and really take her time, feeling like patients got their questions answered and their needs met.

"When I was an employee, we had scribes in the room with us writing out notes – which costs money – and we had one to two staff members just answering phones and returning calls for scheduling and rescheduling," Campbell said. "More staff means more cost for the practice. More cost for the practice means seeing more patients per day. It's a vicious cycle."

The DrChrono system allows her to have patients schedule and cancel on their own time and at their own convenience.

"Having to hire more than one staff member would multiply this cost to a level that would be unsustainable for my business."

Dr. Caren Campbell, Caren Campbell MD Dermatology

"You also are able to take photos within the app, which cuts down on the time needed to upload photos into the EHR," she noted. "At other practices, photos were taken on a camera, and then extra admin time was required to load them at the end of the day into patient charts.

"Photos are an essential part of dermatology, as they show where biopsies were taken, give information to pathologists reading the biopsy, let the surgeon know where the biopsy was taken from, and help us monitor moles or lesions for changes that could potentially be cancerous," she continued. 

"Additionally, for cosmetic patients, it's important to have before-and-afters, in case patients are at all concerned about the treatment or want to see their amazing improvement."

MARKETPLACE

There are many vendors with electronic health records systems on the health IT market, including Allscripts, athenahealth, Cerner, DrChrono, eClinicalWorks, Epic, Greenway Health, HCS, Meditech and NextGen Healthcare.

MEETING THE CHALLENGE

Caren Campbell MD Dermatology offers the EHR's scheduling widget link on its website. Campbell likes that the practice is able to have the scheduling button look and feel like her brand.

The practice uses the available tools, such as the patient portal, to send onboarding forms and allow patients to schedule or reschedule appointments. It uses the integrated ability to take pictures from a patient's chart to cut the process of documenting visits.

"More than 90% of patients schedule their appointments online," she reported. "As a dermatology practice, the documentation can be very visual. So having the pictures is important.

"Patients are able to book appointments and manage their visits," she continued. "Also, all patients get photos of pretreatments, and before every procedure. They are able to fill out forms from the comfort of their house, and this allows me to get access to all necessary information to have meaningful conversations with my patients."

Credit card processing is integrated with Square. The practice is able to charge the patient's card directly from DrChrono. Dermatology can have many elective treatments and therefore staff work with many procedures that require patient payments. Having an integrated way to charge for services ties the whole experience together and allows staff to collect revenue for the practice, she said.

"The charges get associated with appointments conducted and with the integration we can see the payments reflected," she added.

RESULTS

Campbell said she has built a low-overhead, direct-pay and cosmetic practice. She operates two offices with only one employee. She said the patients she treats and the success of her practice rely on the technology used in the offices.

She points to patient satisfaction and retention as hallmarks of success with the EHR technology. She reported she was profitable in her first year of practice, and opened a second office during her second year in practice, including during a global pandemic.

"I'm working in a city where overhead costs have put many out of business, and the cost of paying additional staff for my office in San Francisco with high payroll taxes is between $70,000 and $80,000 per employee per year," she said. "Having to hire more than one staff member would multiply this cost to a level that would be unsustainable for my business.

"When people visit my site, they can easily book appointments, set up a patient profile, and manage their appointments and paperwork before they go to the office or meet virtually," she continued. "This saved my office resources that would be needed to answer calls, schedule and reschedule appointments, and conduct intake of patients."

Many practices have at least two staff members conducting these tasks, she added. Having automation and self-service for patients allows the one staff member she does have to focus on tasks that have a greater impact on the practice, she said.

ADVICE FOR OTHERS

The more automated one can make a practice, and the more seamless the patient experience, the more successful a practice will be, Campbell advised.

"Medicine is in crisis, more so than ever," she said. "Physicians are burnt out, and insurance companies are taking advantage and scapegoating physicians. While insurance company executives make more money than ever, doctors are committing suicide, suffering from burnout and being asked to do more with less. It's an unsustainable situation."

Physicians have become the narcissistic objects of a broken system, she said.

"We are not permitted to be human, and for me, I needed to opt out of the broken system to treat patients the way that filled my soul," she said. "I do not want to rush through patient visits. I do not want to do more with less. I am a healer, and I want to do my job to the best of my ability.

"This requires me to spend a minimum of 30 minutes with every patient," she continued. "In order to pay my bills, including more than $250,000 remaining in student debt, I need to also make a living. The less I spend on employees and overhead, the fewer patients I need to see to pay for all of it."

Campbell wants patients to have a good experience and to feel cared for.

"That's why I am here – to help people," she concluded. "The new EHR gives patients the flexibility to take their time picking an appointment slot that works well for them, it also provides an onboarding process that patients can do in their Uber on the way to the office, and provides a comfortable way to take photos that feels less clinical and awkward for them."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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