Cristina Rivero is office manager for Miami Primary Care LLC, in Miami, Florida. Doctors Armando Rivero and Tatiana Lawer Garcia have been in private practice together for nearly 30 years. Four years ago, Ramon Cardoso joined the team. The doctors specialize in internal medicine and family practice. This is truly a family practice—Cristina is Dr. Rivero’s wife, and the niece of the original founder of Miami Primary Care, Dr. Nelson Garcia-Morales.
The doctors are supported by a team of 10, and the practice sees approximately 40-50 patients per day.
In 2007 the doctors began shopping an electronic health record (EHR) that would help the practice make the transition from paper charts.
After looking at many options, in 2012 the decision was made to implement Quanum™ EHR (formerly Care360®) from Quest Diagnostics. The practice was already using Quanum eLabs from Quest Diagnostics, which meant that the system would automatically transfer information for patients who had already done lab work with Quest into the EHR. This would save time, as the practice would not have to create new files for all of those patients.
At first, it was difficult for the doctors to get used to entering their notes electronically, instead of putting pen to paper.
“During the transition it would take a bit longer to enter the subjective, objective, assessment, and plan (SOAP) notes, along with diagnoses, snippets and paragraphs, because our team had to get used to typing these notes,” said Cristina. “Little by little, everyone mastered this process and now they are pros. Today, some physicians use speech recognition software to enter their notes, others choose to type everything in.”
Early on, the practice also began scanning radiology diagnostic testing into the system, which could easily be attached to the electronic charts.
“Quanum EHR allows us to file and find all of our documents very easily,” said Christina. “When I train a new staff member on the system they find it very easy and user-friendly.”
Cristina appreciates the improved communication that the EHR has brought to her team. “When you have a task, you can assign documents to specific people. As the program administrator, I can go in and perform audits to see who is working on what task, and who is opening what patient chart. This gives me a lot of control of our office workflow, and it’s one of the many things I love about it.”
Similarly, when the practice made the transition from the International Classification of Diseases, Ninth Revision (ICD-9) cataloging system to ICD-10, Cristina said that the EHR made it easy for the doctors to report diagnoses and inpatient procedures.
This is significant because the ICD update increased the number of diagnostic codes from 13,000 to more than 68,000. Added to that were nearly 5 times more classification options with ICD-10 when compared to ICD-9. For many practices, this change was predicted to lead to more errors in medical claims and ultimately denials due to the new specificity required, including age- and gender-related codes.
Quanum EHR, being cloud-based, regularly updates any new codes as they are released by the Centers for Disease Control and Prevention, and provides filters that help a practice diagnose common coding mistakes immediately, and before billing.
“We do all of our billing in house and the help we got from the EHR with the implementation of ICD-10 coding was huge,” said Cristina. “The conversions that Quanum EHR offered us immediately made it easier for the doctors and, ultimately, for our billing staff. The EHR serves up those options for the diagnosis, which is extremely helpful.”
The doctors like the mobility of the EHR. While they certainly use the solution on their desktop or laptop, Cristina says they have used the EHR on their iPads since the very beginning. “They tend to feel most comfortable with an iPad,” she said.
The solution also helps the practice with its lab orders and prescriptions, making them more efficient.
“We love how the EHR offers up eCoupons when there is a savings on a prescription,” she said.
When it comes to Medicare savings programs, Quanum EHR has helped this practice report for Meaningful Use as part of the Centers for Medicare and Medicaid Services (CMS) EHR incentive program.
“Almost 80% of our patients are part of Medicare Advantage plans,” said Cristina. “In 2013, when I did my first reporting for Meaningful Use incentives, Quest Diagnostics was very helpful with the worksheet and the measures. I couldn’t have asked for an easier way to report. The technical support is top notch. I get answers right away.
“Similarly, Quest has always been on top of making updates to meet physician needs. They are improving their EHR constantly, and that is really appreciated.”