Collaboration First: Reliant Medical Group's Epic Implementation

Reliant Medical Group, formerly known as Fallon Clinic, transformed its business to free up funds for an EHR system.

Owner-operated since 1929 by physicians dedicated to “maximizing the health of our patients and the community through expert medical care, compassion, innovative delivery models, medical research and education, and the appropriate use of health care resources,” Reliant recognized its mission as a public service, and transitioned in 2005 to a not-for-profit, tax-exempt organization under Section 501(c) (3) of the IRS Code. Funds that would have been used to pay state and federal income taxes were freed up for investing in everything from capital improvements to an Epic EHR implementation.

But Reliant’s EHR journey really began in 2001 when Alec Cheloff, CIO, and Dr. Larry Garber, Medical Director for Informatics, held lunchtime meetings at 17 provider sites, attended by more than half of the group’s physicians and many nurses, medical assistants, and practice managers to discuss care delivery.

The meetings began with questions like, “Tell us about your practice. What’s working well? What’s not working well?” People would inevitably start talking about parking or HVAC issues, then shift towards healthcare delivery issues.

Those conversations identified 127 challenges in care delivery, right down to notes and results being misfiled and the paper medical record not always being available for appointments or telephone calls. At each and every meeting, Dr. Garber said, physicians and staff spontaneously concluded that an EHR would solve many of their problems.

Building momentum, they then conducted seven “town meetings” that were attended by most of the Group’s physicians and approximately 25% of the staff to identify 140 EHR functional requirements. Following that, a multidisciplinary team of physicians, staff, managers and senior management on the Healthcare Information Technology Evaluation Committee (HITEC) identified and quantified over 100 benefits of an EHR.

Financial Benefits of EHR

With the help of a consultant, review of published studies, and input from managers responsible for relevant areas of the operation, HITEC “baked” the following financial benefits into its budget over the 10-year period following the signed contract:

A 75% increase in use of note-generator tools, reducing transcription costs by 75%

Minimized use of paper charts and associated need for pulling and filing, resulting in a 72% reduction of the medical record staff

Increased patient safety and reduced clinical risk, reducing malpractice premiums by 5%

Elimination of QuickChart (an internally developed results repository) and IBM mainframe computer for IT savings

Increase in online charge entry by providers for a reduction in charge entry staff by 60%

A 21% increase in the recapture of missing office and facility charges

Fewer denied claims, recapturing 27% of written-off claims

A reduction in paper forms to eliminate, on average, 2.5 forms/visit; reduced copying and faxing supply costs; elimination of new and repaired charts

10-Year Total Savings: $63.7 Million

The HITEC also recognized likely financial benefits that were more difficult to guarantee and thus were not “baked” into the budget, but added financial justification for implementing the EHR.

These included reductions in redundant testing, reductions in adverse events, and improved E&M coding levels, all resulting in another potential savings of $44 million over 10 years.

HITEC and the town meetings also identified numerous benefits that were more difficult to quantify, or more focused on healthcare clinical quality, safety, effectiveness, service or satisfaction:

Increased revenue and efficiency when participating in clinical trials due to EHR data

Reduction in space and equipment required for on-site paper chart storage

Improved preventive care (e.g. immunizations,mammograms, etc) and chronic disease management (e.g. diabetic control) rates due to point-of-care alerts and population management tools

Online ordering of tests, to ensure appropriate testing and follow-up for greater efficiency, effectiveness, and patient safety Streamlined electronic prescription renewal with clinical decision support tools to reduce medication errors and monitoring

And last, but far from least,

Improved satisfaction of patients, providers and staff resulting from more efficient, effective and reliable communication, workflows and clinical outcomes

Predicted Benefits Were Achieved

Reliant Medical Group originally estimated, based on the above savings “baked” into the budget, that it would take 7 years to break even from the investment in an EHR. Reliant achieved all of these benefits, and as a result of “Meaningful Use” incentive payments (which were not envisioned in the original budget), Reliant achieved a full return on investment 6 years after the start of the project.

Reliant Medical Group has also seen improvements in clinical quality, safety and efficiency metrics compared to preEHR measures. Now, Reliant exceeds the 90th percentile for most NCQA HEDIS Quality measures. At the same time, Reliant’s cost of care for their diabetic senior patients is lower than 96% of the country.

The moral of the story? With a thoughtfully implemented Electronic Health Record, everyone wins!

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