Seeing the Writing on the Wall
In 1996, Dr. John Guiliana, a podiatrist in a three-doctor, high-volume practice, saw the writing on the wall. Managed care was taking hold and he knew that meant lower reimbursements and a threat to the quality of care he could provide his patients.
"It was clear that the only way we could continue to provide the same quality of patient care was to reduce our costs," he says. "So we began to look at our business processes to identify those that we could redesign to contain costs."
Dr. Guiliana quickly saw the charting process was particularly inefficient. Patients' traditional paper charts had to be pulled for each visit and then re-filed. His dictated notes for each patient had to be transcribed. Then each chart had to be pulled, the transcribed notes inserted and the chart re-filed again. It was a very labor intensive and costly process.
SQL Anywhere-powered Solution Saves Money, Improves Patient Care
To address the time and cost issues associated with traditional paper patient charting, MediNotes Corporation created MediNotes e, a powerful, flexible and feature-rich electronic medical records (EMR) system, powered by SQL Anywhere from iAnywhere, a subsidiary of Sybase.
Designed to be particularly user-friendly for doctors and their staff, MediNotes e enables secure, accurate and efficient information capture right at the point of care.
Thanks to the implementation of the iAnywhere solution, Dr. Guiliana was able to streamline and largely automate the charting process, resulting in cost savings of up to $40,000 each year and improved patient care and patient satisfaction.
More recently, Dr. Richard Blau, a rheumatologist and medical director of the Arthritis Institute of Long Island, implemented MediNotes e with similarly impressive results.
"After I'd finish a full day of seeing patients, I had to spend another three hours doing dictation," says Dr. Blau, who also carries a substantial caseload. "That dictation then had to be transcribed, reviewed and filed in patient charts."
Transcription alone, Dr. Blau estimates, was taking about 35 hours each week.
In addition, there was a lot more work that went into maintaining patient charts. "We handle 1,000 to 2,000 pieces of paper a week, between my dictated notes and lab reports and other correspondence coming in," Dr. Blau says. "It required a full-time file clerk. Because of the volume of paperwork and the time required to maintain patients' physical charts, it was simply not feasible to continue in that manner."
Dr. Blau chose MediNotes e because he liked the system's overall format and found it to be very user-friendly. He also liked that MediNotes e had a rheumatology module with templates that he could easily customize for his practice.
"MediNotes e has significantly improved the quality of my life," Dr. Blau says. "It has saved me a considerable amount of time every day, has made my staff more efficient and productive and has produced significant cost savings for the practice... It's also enabled us to reduce the amount of paper in the office by 95 percent."
The system automates numerous additional office tasks including the generation of physician referral letters, patient instructions, physician orders, prescriptions and E&M codes.
Doctors Guiliana and Blau are not isolated MediNotes e enthusiasts. Two thousand medical sites representing more than 3,500 doctors have purchased this powerful EMR system.
SQL Anywhere: The Heart of MediNotes e
SQL Anywhere's Adaptive Server Anywhere database is at the core of MediNotes e, storing all patient information locally and remotely. LAN connectivity links exam room PCs with the MediNotes e server. Synchronization among remote machines is handled by MobiLink, allowing doctors to access and update charts when making hospital rounds or from other locations.
MediNotes e originally used Microsoft Access as its database. "We moved to SQL Anywhere because Access was just not very robust," Schoen says. "We were also looking for a product that would allow us to provide a synchronization capability for our physicians. We looked at a number of products and found that SQL Anywhere met our long-term criteria."
A Lot of Flexibility and Peace of Mind
"With SQL Anywhere, we've been able to reduce the resources devoted to support, freeing them to focus on enhancing the product," Schoen says. "Because SQL Anywhere is a rock-solid solution, we have only 20 extremely talented people supporting over 4,300 sites (with over 24,000 users, doctors and staff) and our response time is either or immediate or within 5 minutes."
"SQL Anywhere also helps streamline our development process because of its ability to accept objects in a very efficient way," he says. "That makes it very easy for us to make changes to MediNotes e screens on the fly. I really believe it is the best value in the SQL database space. It has provided us a lot of flexibility and peace of mind."