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CASE STUDY 3

CASE STUDY 3: INTEGRATING EMRS AND DISEASE MANAGEMENT AT DRYDEN

FAMILY MEDICINE
Ashley Winans
National University

January 25, 2015

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CASE STUDY 3
Abstract
The Dryden Family Medicine Practice is the basis for a case study in implementing an
EHR system. It demonstrates the technology that this particular practice used previously, as well
as how this led to the conclusion that they need an EHR in the first place as they realized the
limitations in paper charting. The study gives insight into many aspects of EHR adoption and the
different struggles that a small practice will face.

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Case Study 3: Integrating Electronic Medical Records and Disease Management at Dryden
Family Medicine
It is important to note that adopting an EHR is a much bigger undertaking for a small
group practice, as opposed to a larger hospital or practice. Small facilities and clinics will have
minimized IT budgets and a lack of IT specialists. This case study provides a background on
Dryden Family Medicine as well as the process of systems development.
C3-1.
"Pay-for-Performance"
"Pay-for-Performance" is gaining popularity among both federal and private insurances.
According to Tan, these programs establish bonus (incentive) payments for meeting certain
quality targets, such as 95 percent of all immunizations provided on schedule (366). The
example in the section focused upon disease management. For example, the aim of this
particular speciality is to help patients improve their self-care for chronic conditions,while
screening patients periodically to ensure they are meeting their goals (365). The aim of payfor-performance is to give financial incentives to clinicians for better health outcomes (typically
measurable ones, like process outcomes), which may include lowering blood pressure, or,
providing informational materials, counseling patients to stop smoking. Monthly reports may be
generated to support this, and thus the need for an EHR would arise too track this information.
C3-2.
Cost-Benefit Analysis

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CBA, or Cost-benefit analysis is utilized as a tool to decide whether a practice should
invest in an EHR. Although CBA assists in budgeting and planning (where the most financial
gains will be had), it fails to measure more intangible factor, such as provider and patient
satisfaction. The long-term benefits of an EHR are also difficult to project. CBA also
underestimates the risks of doing nothing., which may be the most harmful choice of all.
C3-3
Lost Profits
If the practice had not adopted and implemented an EHR, they may have seen additional
costs in some other ways. For example, average monthly revenues increased by 11 percent in
the first year following EHR implementation and 20 percent in the second year, compared with
the baseline year (367). This is also just the beginning of the profits that the practice may miss
out upon.
Other Losses. They would also miss out on the opportunity to have more accurate and
updated billing codes, as well as all of the other benefits an updated EHR would bring them. As
mentioned previously, there also exists the intangible costs such as of patient and provider
satisfaction and a higher as well as more accurate level of care for patients.
C3-4.
IT Readiness
In terms of IT readiness, this case study does an excellent job in identifying a few key
factors which Dryden Family Medicine had either learned from or felt that they had done well.
For example, the practice had a strong prior relationship with their software vendor. The practice
already had a billing system in place prior to EHR implementation, which aided in the transition.
The office manager became more versed in IT, and was able to help with the transition as well as

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provide the necessary training and in-house IT support for the practice. As this is a rural practice,
the manager taking on an IT role is critical as there are fewer resources nearby. These are two
key milestones that I think any practice could learn from and adopt.
Areas of Opportunity
Two other areas that the practice should have been in place, but were not were the
importance of coding issues as well as increased autonomy of staff. Ideally, nurses and staff
members should be prepared to take on new duties as well as be coached on and aware of the
flexibility that they will need to exhibit. As for coding, the physicians seemed overwhelmed with
the time it took to code their diagnoses (ICD-9); however, this amount of time decreased with
practice.
C3-5.
Challenges for Small Practices
Yes, I do feel that there are a separate set of challenges for smaller practices to take on
HMIS projects such as EMR implementation as compared to a larger, multi-provider practice.
First of all, the financial aspect can be a set back, as they will have less funds to pull from. There
will also be fewer individuals in the practice, such as IT professionals, to pull from in order to
make a transition to an EHR system successful. This practice chose to develop someone in the
practice as an IT consultant in order to help with the transition and for the needs that would
arise with the new system.
Incentives
It may true that they will have less of an incentive. The smaller a practice is, especially
in a rural setting, the easier it may be for them to get away with simply utilizing paper charts.
They may not have access or knowledge about many of the benefits available to them, or see

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how an EHR could benefit their practice. Rural practices, such as the one in this case, are also
more prone to resistance from providers from ever adopting and implementing the system in the
first place.
Conclusion
There are numerous things for small practices to consider when adopting an EMR or
HMIS.This process can be more difficult for small practice as the lack funding and staff with IT
training. However, the end results and financial gains may make the entire process valuable and
worth while.

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References
Clinical Decision Support Systems. (n.d.). Retrieved January 10, 2015, from
http://www.openclinical.org/dss.html
HealthIT.gov. (n.d.). Retrieved January 10, 2015, from http://www.healthit.gov/policyresearchers-implementers/clinical-decision-support-cds
(n.d.). Retrieved January 10, 2015, from http://www.chcf.org/~/media/MEDIA LIBRARY
Files/PDF/C/PDF ClinicalDocumentationEHRDeploymentTechniques.
Tan, J. (2010). Adaptive Health Management Information Systems Concepts, Cases, and
Practical Applications, third edition (3rd ed.). Sudbury, Mass.: Jones and Bartlett.