"When you look at what an electronic medical record does, you can't just see it as a substitute for transcription," says Hal Teitelbaum, M.D., managing partner of Crystal Run Healthcare, a multi-specialty group practice 65 miles northwest of New York City. "One of the major roles of an electronic medical record should be the standardization of health care, using the principles developed in evidence-based medicine, to make sure everyone is using best practices wherever possible."

In choosing an information system for the rapidly growing 25-physician practice, Teitelbaum and his colleagues looked for one that was flexible enough to handle Crystal Run's various specialties, scalable to grow with the practice and full featured to handle its clinical and e-health needs. They also wanted a single vendor to supply both medical record and practice management systems for greater systems compatibility and efficiency.

Crystal Run found the systems to meet its needs in the NextGen® Electronic Medical Record (EMR) System and NextGen Enterprise Practice Management (EPM) System from MicroMed Healthcare Information Systems. The two systems easily exchange data with each other and work together to provide the electronic infrastructure for the practice. NextGen EPM was implemented in August 1999 and NextGen EMR in January 2000.

Using NextGen EMR's flexible templates, the Crystal Run physicians have built specialty-specific clinical modules that form a single, standardized system but also meet individual specialty needs. "Wherever possible, we've tried to use the same methods for gathering, displaying and reporting data for every subspecialty," Teitelbaum says. "We want everyone to be able to go into each other's records and see basically the same thing. The tools that MicroMed provides have allowed us to use the same computer-human interface and yet have different data points available for selection."

A cardiologist who logs onto the EMR system sees the same introductory screens as a gastroenterologist or oncologist, but the choice of selections is specialty specific to speed up the selection process in the exam room. By tapping twice, however, the physician can view the full general medical range of choices.

Prescription writing is done completely on the system. Before the NextGen EMR system was installed, the physician had to make four separate entries in the chart for each prescription written, making sure each time that prescription information was legible. Now all prescriptions are generated and all documentation accomplished by simply entering the information once.

The Microsoft Windows-based system is simple to learn, and fairly fast and easy for the practice itself to modify. One of the system's key benefits, Teitelbaum says, is the Microsoft SQL Server database, which gives NextGen EMR its strong reporting capabilities. Crystal Run has created reports to produce lists of patients who are due for particular screenings or visits.

"We can analyze patient data monthly, identify patients who need to come in, and then create a mailing list and letter to send them," Teitelbaum says. In the case of drug recalls or warnings, all the system needs is the name of the drug to be able to identify and give demographic information for affected patients.

The NextGen systems' shared workflow data lets physicians view their current and future schedules and indicates when patients have arrived in the waiting and exam rooms. All of the patient's demographic information is available during the visit. And using an electronic superbill, the physician can pick a diagnosis for the patient, assign a code and submit the charge for direct transfer to the NextGen EPM billing system.

Crystal Run is going a step further by building into the system the capability to help physicians indicate the evaluation and management code supported by their documentation and the level of complexity of the patient's condition. "This will move us from point-of-service documentation of the visit, which we're doing now, to point-of-service charge capture," Teitelbaum says. "We'll eliminate effort at the front desk and save a step so that information is more accurate and available immediately. "

The practice has grown quickly, a trend expected to continue as Crystal Run adds more specialties, physicians and sites. "Having the infrastructure - the management systems and clinical systems - in place will facilitate our growth," Teitelbaum says. "The whole NextGen system is extremely scalable, so it will be easy for us to add more partners. We see this as an engine for practice growth and development. "

The practice sees approximately 300 new patients per week. Ultimately, its goal is to provide 90 to 95 percent of the medical care an individual will require in his or her lifetime. This includes providing primary care across the continuum - pediatrics, adult medicine, obstetrics - gynecology - and adding subspecialties such as rehabilitation, ophthalmology and sports medicine.

"We see this as an engine for practice growth and development." Hal Teitelbaum, MD

"The electronic medical record allows us to improve the quality and efficiency of the care we provide," Teitelbaum says. "We have a focus on customer service, which ultimately is the face of any practice. NextGen EMR and NextGen EPM help us put that philosophy into practice by providing better service to our patients."