The three legged stool of EHRs — Dr. Michael Weinstein recounts why Capital Digestive Care selected gMed's gGastro

In 2009, Silver Spring, Md.-based Capital Digestive Care formed when seven gastroenterology groups merged. At the time, three groups had converted to EHRs, while four relied on paper records. It wouldn't be until 2011 when the group decided to select an EHR.

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Michael Weinstein, MD, president and CEO of Capital Digestive Care shared Capital Digestive Care’s 18-month EHR search story with Becker's ASC Review. 

Spurred on by financial incentives in CMS' American Recovery and Reinvestment Act of 2009, Capital Digestive Care assembled a team comprising the clinical, administrative, technical, medical records and coding and billing departments to search for an EHR. The team had to be multifaceted to ensure the selected EHR would be acceptable for each department.

"As a group of more than 50 physicians we proceeded in a slow and deliberate process that took 18 months to complete to reach a decision point that was acceptable," Dr. Weinstein said. "Each step of this process required regular communication between physicians, administrators and staff."

After the team was selected, the practice conducted a readiness assessment, identifying every aspect of the clinical and administrative workflow and deciding how it would translate into the EHR. This process helped the selection team create a list of what the EHR's standard functionality should be.

The two most important pieces Capital Digestive Care was seeking in an EHR system were:

  • Easy interface with practice management systems, laboratories, hospitals and endoscopy centers
  • Interoperability so it was simple for physicians to use regardless of where they were practicing.

Dr. Weinstein said gastroenterologists spend up to 50 percent of their time at endoscopy centers. He said, "The seamless flow of information to and from the office and endoscopy suite is critical to clinical care and achieving maximal EHR efficiency." In his experience, EHR inefficiencies are most evident when there are issues with the interface.

After the initial pitching process, the Capital Digestive Care EHR selection team traveled to four practices to see their final candidates in use. The options were gMed, a Modernizing Medicine Co.'s gGastro and three others.

Then the road trip began.

The team went to Minneapolis, Rockford, Ill., Denver and York, Pa., to see the systems in action. Dr. Weinstein met with IT managers, physicians and superusers at each location. The team witnessed the EHRs in use and got down to the brass tacks with people using the systems in an everyday environment.

"After that we decided on gMed," he said. "One of the reasons [behind that] was because in a GI practice you need a three legged stool with your EHR. You [need to have] your billing and collections, your office records and your endoscopic system. … gMed has all that in a seamless interface. With that in mind we decided to do gGastro in the office and throughout all of our endoscopy centers."

The change has been well-received and like all gMed users, Capital Digestive Care can call a company representative when a problem arises. However, Dr. Weinstein said by having the entire practice on the same EHR system, there have been next to no interface or vendor issues.

While gMed may not be as robust as some of the other options the group considered, the integration between each "leg of the stool" more than makes up for that, he said.

And the physicians like the system too. The gGastro system allows for several points of customization, including for note taking. gGastro allows physicians to dictate notes, use voice to text, type, use a scribe or even use automated ribbons for note taking. Dr. Weinstein said, "We didn't have to drive everybody to do the same thing, we could allow the physicians to have some flexibility and they were happy."

As an added perk, the gGastro system has several administrative friendly customization options. For example, in healthcare there are multiple different ways to say the word "big." An administrator can go into gMed and restrict the vast terminology to the same throughout the entire system. By limiting the number of ways a physician can describe a large anomaly to one, gGastro creates a set of mineable analytics. The hardest part, Dr. Weinstein joked, is getting the physicians to agree to just one term.

Since the implementation
Since Capital Digestive Care implemented gMed, the practice has made a number of improvements to upgrade their gGastro experience. When Capital Digestive Care first rolled out gGastro across its several Maryland and Washington, D.C.-based locations the system was being hosted on an offsite server farm, leading to the occasional outage.

As Capital Digestive Care's servers were nearing the end of their lifespan, the group was faced with another decision: spend a considerable amount of money purchasing new servers or pivot to gMed's cloud-based servers.

"We decided to move to the cloud," Dr. Weinstein said. "It's helped a lot. We've had minutes of downtime, if that. When we were on our own servers there were always disruptions. Now that everyone is on the cloud, everything is on Modernizing Medicine. If there's a problem, we only have to make one phone call. I can tell you we haven't had to call. It's worked better since we were on the cloud."

Now that Capital Digestive Care is on the cloud, scalability was made effortless. Where before the group would have to weigh expansion with an eye to infrastructure, today the EHR is completely scalable and practices can be added simply by reaching out to gMed.

As an administrator and a physician, Dr. Weinstein has had ample experience with both sides of gMed's gGastro system. From the interconnectedness of its report writer to the workable metrics and customization of its practice management system, one aspect stands out to him: the fact that the system is specifically for GI.

"If you look at other multispecialty systems you see things that have no relevance to GI and it's harder to lock them out," Dr. Weinstein said. "You have pages that are encumbered by medical information that is of no use to a gastroenterologist. In that respect that customization for GI makes the notes more efficient for us. I can get everything I need on a single screen without having to dismiss information or scroll."

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