Building an E-Health Infrastructure for Growing Medical Practices. Practice management systems have grown from simple billing and scheduling applications to systems with complex reporting capabilities and interfaces for data exchange with clinical applications. No longer standing alone, practice management systems have become part of the e-health infrastructure for practices of all sizes.

Crystal Run Healthcare, a multi-specialty group practice 65 miles northwest of New York City, had used a proprietary practice management system that couldn't handle the practice's rapid growth and was difficult to modify. "If we needed an additional report, we had to go to the vendor. Some months later, they would tell us what it would cost and give us the report, if they could do it at all," says Hal Teitelbaum, the practice's managing partner.

In choosing a comprehensive new 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 practice management and medical record systems for greater systems compatibility and efficiency.

Crystal Run found the systems to meet its needs in the NextGen® Enterprise Practice Management (EPM) System and NextGen Electronic Medical Record (EMR) 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.

One of the biggest advantages of the new Microsoft Windows-based practice management system is its ability to generate reports. "The use of the Microsoft SQL Server database makes the process amenable to levels of analysis that would not be available using most proprietary databases - and the process is easy enough that we don't need a vendor's help," Teitelbaum says. "NextGen EPM gives you a tremendous number of options so that you can generate virtually any standard report with a wide variety of modifications."

Data can be exported to Microsoft Excel for analysis, or Crystal Reports or Microsoft Access can be used to query the system. However, nearly all of the reports Crystal Run needs can be created using the report generator. And while the monthly report of productivity by CPT codes took days to run using the previous system, it now can be run in less than an hour.

NextGen EPM's reporting capabilities, combined with increased electronic claims submission, also have allowed Crystal Run to improve its collections ratio. Almost all interactions with payers, including Medicare, are now done electronically.

When staff members answer patient calls, they immediately go to the telephone template in the patient's record, which opens in seconds. They enter the data and e-mail it to the nurse and physician, making it available instantly. The nurse can then e-mail a question to the physician. When the process is complete, a document is generated that goes through the entire flow with time and date stamps. The document is locked and becomes part of the permanent record. For security, the people answering the phones only have access to the telephone-related template and not to the full medical record.

A special feature of NextGen EPM and NextGen EMR is that information can easily flow between the two systems with the use of an interface engine.

NextGen EPM and NextGen EMR also interface through the scheduling system. The front desk staff simply checks a box to indicate a patient has arrived, and a visit is created in the electronic medical record. Physicians and nurses can see the same schedule in NextGen EMR that the office staff is using in NextGen EPM, and they are prompted when the next patient arrives or a visit is canceled.

Crystal Run plans to bring patients into the electronic loop through MicroMed's NextMD Web portal. The portal will allow patients to use the Web to register, provide or change insurance information and demographics, request prescription renewals or appointments, and view test results.

"Having the integrated NextGen product allows us to entertain all these possibilities," Teitelbaum says. Further out, Crystal Run may provide limited access to other areas of the patient's medical chart, perhaps allowing them to update social information and their family history, as well as viewing and paying balances online.

"We're great believers in the concept of branding in medical care," Teitelbaum says. "Once you've created a high-quality practice that has established standards in the way it treats its patients, both in terms of service excellence and medical management, all of that needs to be branded - and we do push the Crystal Run Healthcare brand.

"If we utilize new tools such as NextGen EPM and NextGen EMR, we can stay one step ahead of where we need to be - and we always want to be at least one step ahead." Hal Teitelbaum, MD

"Our perspective is basically that as much as health care has changed, that change is opportunity if we change with it. If we utilize new tools such as NextGen EPM and NextGen EMR, we can stay one step ahead of where we need to be - and we always want to be at least one step ahead."