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148 Section IV. Economicsfor an overview. The APCC’s management structure consisted of a medical director, anurse manager, two assistant nurse managers, two administrative assistants, and a clericalstaff member. The APCC employed seventy-eight staff members, including patientcare technicians, nurses, and clerical staff. The practice information system consisted ofa mainly paper-based, traditional charting system that was not standardized throughoutthe four suites. Charts were kept in file rooms within each suite, and managementof the charts was the responsibility of the suite’s file clerk and the other clinical staffmembers. Some medical information was also available in an electronic medical archiverecord system, which included laboratory data and various notes and reports. Mostdocumentation and the associated work flow of patient visits, telephone calls, correspondence,laboratory, and imaging was contained in a paper chart. StarPanel wasimplemented in this milieu both as a test for the clinic and for codevelopment andenhancement of the product.But Dr. Jirjis did more than a standard test implementation; he altered StarPanel’sfoundations by guiding creation of a message basket function—an electronic toolallowing clinicians to communicate regarding patient care and easily send informationto StarChart. Thus, StarPanel could be tailored around the uniqueness of the clinicalwork flow of each specialty clinic. This innovation made adoption of StarPanel mucheasier for other clinicians.With StarPanel usage increasing and paper costs decreasing, an economics Ph.D. conducteda return on investment (ROI) study of StarPanel. For November 2001, in whichthere were 4,103 patient visits, the results were compelling: 32 percent less time and51 percent less cost per patient visit using StarPanel meant a reduction in cost from$294,513 to $144,917—$149,596 savings that month alone—and projected annualsavings of $1.8 million for the APCC.The study said that StarPanel cut costs of physicians, office assistants, patient caretechnicians, and patient service coordinators (Tables 13.3 and 13.4). Per visit the costfor physicians was cut in half to $25.82, for technicians to $1.62, and for patient servicecoordinators to $1.33. More time was required to enter data into StarPanel; thus theper-visit nursing costs increased from $6.13 by a nominal $0.42 to $6.55. The cost ofoffice assistants as well as medical information assistants (those who previously pulledand transported charts) was completely removed. These employees were placed in aredeployment program and reassigned to other parts of the organization that had sufferedlosses through attrition.The expanded pilot in the APCC had required a projected initial investment of$150,000 for technology for the entire clinic. It seemed that StarPanel appeared readyfor enterprisewide implementation to help the institution achieve its financial goals.TABLE 13.4. Adult primary care center personnel costs.Personnel costs Visits Rate ($) Process cost ($)DirectPhysician 4,103 25.82 105,939.46Office assistant II 4,103Patient care technician 4,103 1.62 6,646.86Patient service coordinator 4,103 1.33 5,456.99Registered nurse 4,103 6.55 26,874.65IndirectMedical information assistant I 4,103Personnel subtotal 4,103 35.32 144,917.96