Pediatric Informatics: Computer Applications in Child Health (Health ...

15 Pediatric Care Coordination: The Business Case for a Medical Home 209
since the amount of information that is recorded at each visit generally increases
significantly. Thus, in the event of an untoward event that leads to litigation, the
amount of information (particularly pertinent negatives) available to defense attorneys
might make the difference for successfully defending the suit. For this reason,
some insurers have reduced premiums for physicians using EHRs. 12,13
Effective automation has the long term effect of enhancing revenues and reducing
costs to actually produce a return on the investment made in computers and
software. These results have been demonstrated in businesses from car repair to
robotics manufacturing, and health care delivery is no exception. The multitude of
methods by which revenues are increased and costs reduced should be considered
in these calculations to create a business case to justify the expenditures and understand
the return on investment. 14–16
15.4 Business Case Study
Let’s evaluate a typical business analysis of an EHR implementation in a pediatric
practice, starting with the following assumptions:
Five provider practice, three pediatricians, and two pediatric nurse practitioners
� Currently dictate records, with two transcriptionists who comprise 1.5
FTEs
Two receptionists who manage entry of the superbills into the billing system and
creation of follow up appointments
Three office nurses, two medical assistants whose functions include:
� Finding and verifying lab and imaging results
� Conducting office lab tests
� Patient education and distribution of educational literature
� Check patients into the “clinic area,” do brief history, vital signs
�
Check all transcriptions for typographic errors and grammar
An office manager who makes sure everything gets done and that collections
are healthy
The worksheet in Table 15.1a provides a cost breakdown of the current practice
situation. The practice is operating at a break-even level, with little or no profit from
year to year. Medical assistants work at a level of two FTEs, and nurses at 3 FTEs,
and a substantial amount of their work relates tracking and evaluating lab results,
as well as proofreading transcriptions.
Assumptions for the pro forma include the following (Table 15.1b):
The practice decides to automate its medical record, and purchases a system
with the following characteristics:
Direct data entry of progress notes, histories, and physicals using templates
Interface with the practice’s hospital reference lab and x-ray department to
receive reports in batches