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Current and Breaking News for Professionals, Consumers and Media |
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MIMA decided to expand its IT infrastructure to allow for all of our 120+ physicians and 800+ support staff to transition to electronic medical records. Over the years we have experienced dramatic improvements in efficiency as the number of our FTE staff remained the same while adding dozens of physicians to our organization. We have experienced significant cost savings and dramatic improvements in efficiency in almost every area, as well as an unforeseen improvement in patient relations as a result of electronic communication between patients, doctors, staff, pharmacies and other organizations. We have also improved the quality of care that we provide to our patients through responding to their requests more quickly and minimizing potential drug interactions. After 12 years with Electronic Medical Records, we would never want to return to a paper based system. IT INFRASTRUCTURE Technology is no stranger to the Melbourne area as the Kennedy Space Center is a short drive from any of the 17 MIMA locations. Through Dr. McClure’s leadership, MIMA has invested heavily in its IT infrastructure. The company selected a well qualified Chief Information Officer in Gary Wright who has guided the technology side of the company over the entire journey to date. His background and experience building IT infrastructure and integrating practice management systems allowed him to take the MIMA IT department from just himself to over 25 people that support the entire organization today. As a result, MIMA has established one of the most advanced IT infrastructures for any medical practice anywhere in the world. In providing a strategy for the development of the IT area, Wright has used a philosophy of being prepared. MIMA has developed several redundant systems and processes ensuring virtually perfect uptime for the users. The necessity to connect over a thousand users and devices in the MIMA network, resulted in a variety of challenges that caused us to arrive at our current infrastructure. Today, we utilize a meshed fiber optic network with inter-connections to four AT&T offices (our local telephone company), providing multiple layers of resiliency. From the facilities housing our datacenters, we have installed the redundant fiber connections to different AT&T offices, and traversing different paths from our facility, thus protecting us from severed fiber. In symphony with the redundant fiber optic network, we have constructed multiple datacenters housed in hardened facilities, important in hurricane prone Florida. We have done this to protect us from the unlikely event that one facility is unable to function so that our mission critical needs can be met. Redundancy extends to data backup as well. MIMA has developed three levels of back-up: for real time system backup at both data centers, end of day backups (kept in the data center), and a third back up which is stored in a secure off-site location. Insufficient air circulation and high temperatures can not only harm your computer systems, it can also cause your computers to run more slowly as the processors overheat. MIMA has addressed this problem by providing redundant oversized air handling systems, which alternate cooling the data center ensuring that all cooling needs are met. Power is another area that is a concern in the functioning of large data centers. Over the years, the power back-up ability has been enhanced so that today, each data center has sophisticated power backup that will keep the data flowing should the entire region of Central Florida lose power. Should either or both data centers lose power, the UPS will sustain them during the transition to our diesel generators. The generators will run for up to three days before any additional fuel is required. Threat of fire is a serious concern for any datacenter. Early detection and prevention must be the top priorities. We have installed VESDA (Very Early Smoke Detection Apparatus) in our datacenters. Conventional detection is often too late for use within a datacenter, where the business continuity relies on operational systems. The VESDA systems detect issues well before visible smoke exists. The risk for improperly extinguishing any fire is also of utmost concern. We have implemented a non-water based system that is friendly to both our datacenter equipment and human life to ensure that we will minimize any potential damage to our systems should fire become an issue. We have taken steps to ensure that any risk of fire is detected at the earliest stage, and in the unlikely event a fire were to occur, the method of extinguishing that fire would result in minimal or even zero downtown for the business. INFORMATION TECHNOLOGY DEPARTMENT Wright credits his team and his purposeful focus as the means to creating such an impressive infrastructure. ”Our mission is to continually develop, maintain, and support a modern, state of the art technology infrastructure, enabling clinical staff to efficiently deliver superior medical care throughout MIMA’s service areas,” adds Wright. One of the many critical members of Wright’s team is Phil Slover, his IT Operations and Development Manager. Slover and Wright have developed a strong team of IT professionals that support every aspect of the IT hardware and software infrastructure. A well-entrenched help desk is logged on and ready to address any problems in a timely fashion, routing problems to the Technical support or network operations department as necessary for hardware and network problem follow up. If the problem is of a software nature, the Application Support and Development departments are prepared to handle the support and interoperability considerations required to resolve the problem. Over the years, MIMA has integrated many devices into our EMR as well as a Heinz variety of software applications with at least 57 different software applications (see Table 1). Practice Management Clinical and Diagnostic Administrative Internally Developed Security/Utility Infrastructure Management Practice System EMR Payroll Web Sites Help Desk Claim Scrubbers Lab System Accounting Swap shop Anti Virus PT communications Image System SQL Fire Wall Transcription MS Office VPN Scanning Oracle Secure Mail ELECTRONIC MEDICAL RECORD EXPERIENCE Over the years, MIMA has experienced every challenge that a radical change in an organization represents. Initially, we had cultural hurdles to get through as many physicians were reluctant to implement the new technology due to unfamiliarity and fear of what computers might do to their established and reliable daily routine. “Why fix it when it isn’t broken!”, said Dr. Baney who initially resisted the EMR system and is now a very happy user. “We definitely experienced a cultural revolution as we moved from paper based systems to electronic medical records, but we are much better for it”, said Dr. McClure. Probably the greatest benefit is a much more efficient environment for physicians to work. Having our records stored electronically allows us to retrieve the patient record on demand. No one needs to look for a chart and once entered, the data is never missing or unreadable. Whether we are in our office, at home or on a trip anywhere in the world, with an internet connection, we have access to our chart and we can participate in the care of any patient in our system. We can now respond to patient inquiries without waiting for staff members to find a chart creating more satisfied patients and less frustrated doctors. The second most valuable benefit is the desktop function, an area in the EMR that keeps track of each pending physician task, including patient requests, staff member needs or referring doctor inquiries, as well as an area where all documents that need to be reviewed and signed are stored. The physician knows how much work needs to get do before leaving the office for the day, allowing the physician to leave the office every day at a reasonable time. Also, On-call coverage is more efficient and comprehensive, as all MIMA patient charts are available via internet browser, using citrix in a secure and encrypted manner. This provides not only a higher level of patient care, but a higher level of satisfaction for the on-call physicians. As technology catches on at all levels of society, our patients have now begun to reach us on line through our patient portal. Not only are we able to communicate with our patients over the internet, we can also provide appropriate recommendations to have them come in for a visit or to wait for their next scheduled appointment based upon the information that they provide us. With the ability to dictate directly into the EMR, many of our physicians have totally eliminated their transcription expense, saving our practice a significant amount of administrative staff time coordinating dictation tapes and paperwork. By dictating directly into the EMR, all documentation is available instantly practice-wide. Additionally, prescription renewals are streamlined, eliminating the need to pull charts, verify requests and re-file charts. Refill requests are sent electronically directly to the pharmacy. Our clinical staff is very happy that we have an electronic medical record in place. They have truly enjoyed the dramatic and improved speed in accessing patient chart information, allowing them to more quickly process patient requests and forward chart information to outside doctors and hospitals without printing any paper. We are also able to process internal and external referrals more efficiently. The office staff experiences improved speed and the ability to process patient requests for assistance without multiple phone calls and voice mail messages . Because each staff member also has a desktop, messages are typed directly into the computer and associated with the patient chart so that no messages are lost and all entered items show on the desktop and are ready to be followed up on. In addition, the billing department can access patient records and re-file claims to reduce the number of days for outstanding claims. Virtually all staff would be unwilling return to working with paper charts. Another added bonus is that we have eliminated the burden and cost of transportation of our charts between our many locations. Although we initially invested in the electronic medical record in order to make our practice more efficient and reduce costs, we have also experienced a significant improvement in patient relations. Patients are very aware that our office is quicker in responding to their requests, with fewer call backs and better tracking. Via the patient portal, patients can now update their registration data from home prior to their visit. They can also speed up and help perform the documentation of their chart with registration and medical question data through our in-office Kiosks. Through secure internet technology, our patients can communicate with their physician from home and we are planning to allow patients to schedule their own appointments. The E-prescribe feature allows patients to get their prescriptions faster. Also, in the event that the patient’s regular doctor is not on-call or available, the patient gains further confidence in our practice as the covering physician has easy access to the patient’s medical information. While we have made a significant investment in our IT infrastructure, we have been rewarded in many measurable and immeasurable benefits with minimal downside expense and problems. While the EMR can cause frustration and in some cases more time to document the patient visit, the value of improved patient satisfaction, improved quality of care and lower operating cost structure have allowed us to realize a high return on investment. Our subjective benefits that are hard to quantify include: A much faster ability to respond to patient requests and needs, as many are handled on the first call; The constant need to pull and file charts has been eliminated; The EMR has allowed us to improve patient safety. EMR technology allows the physician to immediately know if the drug they are prescribing has a potential interaction with any other drug the patient is taking. This capability eliminates many potential adverse reactions; Direct access to the patient’s pharmacy allows patients to pick up their prescriptions at their pharmacy and replacements are rarely needed; Through the desktop, patient requests and notes are no longer lost, misplaced or misfiled; Covering physicians are not only willing but are also comfortable in treating other doctor’s patients; The overall organization and efficiency of the practice; The practice appears more professional; The ability for the practice to have the patient enter information , which the staff verifies and converts into the medical record, speeds up the documentation process and involves the patient in their own care; And, the ability to process internal and external referrals improves physician satisfaction as well. We have also achieved lower operating costs due to improved staff efficiency, improved space utilization, dramatic reductions in transcription costs, and the elimination of costs related to moving charts to our different facilities. We are very pleased with our investment and the results we have achieved over our 12 year journey. Now that our physicians are on EMR, none of them want to return to a paper based system as the benefits of our EMR dramatically outweigh our paper based methods. We are acutely aware that the future of medicine will require efficient and streamlined operations. Only through an EMR will practices be able to achieve the efficiencies and reduction in costs that are required to be competitive and to survive as cost cuts from the government and insurance companies promise to negatively impact our industry. MIMA Technology Solutions, Inc. (MTS) is a wholly owned subsidiary of Melbourne Internal Medicine Associates (MIMA), a 124 Physician group practice located in Melbourne, FL. MTS was created by MIMA to leverage its 12 years of experience with Electronic Medical Records to help physicians implement and improve EMR in their practices. We have developed a strong expertise in the planning, implementation, training and support of Electronic Medical Records. Contact: Bart Carmichael President Bart.carmichael@mima.com 1223 Gateway Boulevard Melbourne, FL 32901 (321) 409-6850 MIMA Technology Solutions Subscribe to our FREE Ezine and be eligible for Health News, discounted products/services and coupons related to your Health. We publish 24/7. HealthNewsDigest.com We videotape Press Conferences, produce Satellite MediaTour's, B-rolls, PSA's, - all with distribution: HealthyTelevisionProductionstvmike13@healthnewsdigest.com Top of Page 
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