Arkansas Specialty Orthopaedics (ASO) had the NextGen software it needed to adopt an electronic medical records system in 2008, but none of its 20 providers had made the switch from paper charts until this spring.

 

That's when Gordon Newbern, MD, an orthopedist who specializes in knee and hip reconstruction, decided to do it.

 

Newbern went digital without telling ASO Executive Director Jennifer O'Brien or Cara Petrus, electronic health records coordinator. They were surprised to learn what he had done but not surprised that he was the trailblazer.

 

"He drives a Prius," explained O'Brien.

 

While Newbern's switch was somewhat sudden and unexpected, O'Brien and Petrus had been laying the groundwork for a practice-wide transition for quite some time. ASO was using NextGen's practice management software that it had purchased along with the electronic health records system, and they were trying to prod the physicians to take advantage of the medical records capabilities. But it wasn't until a single, typically forward-thinking doctor took the plunge this spring that the momentum began to build. "There are a couple of reasons it took so long," O'Brien said. "I don't know that the organization was really ready. I don't know that the physicians were really ready."

 

Once Newbern proved it worked and became an ambassador, others were willing to change. Sports physicians next went digital, with the rest of the practice's 20 physicians and 175 staff members quickly following. "We have very competitive physicians here, and so when one does something, they all want to do it," Petrus said.

 

O'Brien and Petrus at times have had to hold hands and at times have had to give a gentle little push in order to bring everyone on board. One key to success has been understanding personalities – in particular, knowing who was enthusiastic and who was reluctant. In one case, one of each who worked beside each other were a perfect pair because the reluctant adopter could get advice and help from a peer. Meanwhile, Petrus responded immediately once physicians showed interest so they quickly saw the benefits. She is always ready to answer questions and has worked with physicians at all hours of the day and on weekends to help them set up their templates.

 

O'Brien and Petrus say the advantages of a digital system already are being realized. It allows physicians to instantly call up a patient's records rather than rely on hard-to-find printed charts and a patient's memory. The practice is adopting a discrete data system with drop-down menus and templates so physicians not only can easily find information about a single patient but also can compare data across patients for research purposes. Later, the NextGen software will be installed on doctors' iPhones so they'll be able to access information when they are out of the office. Petrus estimates that the practice's records consume the equivalent of about 10 packed two-car garages – storage that costs a lot of money. All of those records eventually will be digitized and destroyed.

 

Jeanine Andersson, MD, who specializes in hand surgery, said she expects the system to lead to more efficient patient visits and improved care. "It's got pros and cons," she said in between seeing patients. "I think any time you do any new system, it can be quite difficult to get used to a transition. But now, it's much more efficient as far as looking up patient records. Everything's centralized. There aren't charts that get lost. It's quicker to send letters in our dictation to our referring physicians."

 

Lessons learned? Petrus said she won't implement anything unless she is completely sure it will work. O'Brien said it's best to avoid Band-Aid solutions. One such quick fix seemed to work for a time but then caused more problems. "It means brainstorming what are all the possible ramifications of an implementation, even the smallest implementation, and then figuring out what could possibly go wrong and asking all the follow-up questions of 'If, then, what?' And then being 150 percent sure that it's going to be solid," she said.