WRS EMR is Music To ENT Physicians’ Ears

Dr. Raymond DeMoville enjoys listening to music that emanates from Music City, which is in close proximity to Mid State ENT’s offices in Hendersonville and Gallatin, TN. But what’s music to Dr. DeMoville’s ears is the harmonious sound of Mid State ENT, which has been running like a fine tuned instrument ever since he implemented WRS web-based EMR and practice management system.

Dr. DeMoville, and his partner, Dr. Michael Lee have been hanging their white coats at Mid State ENT for 13 and 14 years, respectively. The pair also work at Hendersonville Medical Center and Sumner Regional Medical Center as well as at two surgery centers. Each physician treats about 90 patients per week. In addition, they employ an NP, who sees around 40 patients a week.

Mid State ENT has been through the rigmarole of using several different systems over the past decade. “Ten years ago we started using a system that we got disenchanted with. We never really produced a note on it. Then we went to another system, which we used for three years. I stuck it out because I hate to waste money so I made myself do it. But I took twice as long with my notes because the voice recognition was so bad. It was an electronic note. It didn’t have billing associated with it and it didn’t code for you. The word recognition was very poor. You’d say Celebrex® and it would say, ‘sell some brex.’ It produced a fair note. It kept a database, but it was our own database; it was not web-based, so we had to have it up all the time to access it from one office to the next. It was an issue transferring between the two (offices),” said Dr. DeMoville.

Noting in his review that the practice also used AdvancedMD, Dr. DeMoville said, “It was atrocious. You would dictate and what it would put out as a note was terrible. You’d have 12 pages for a one page note. Your data was in there, but even we couldn’t find it. We were trying to read our own notes. We were very dissatisfied with that,” said Dr. DeMoville.

Gone EMR Shoppin’

In addition to WRS, Mid State ENT evaluated about five Electronic Medical Records, including eClinicalWorks. “We didn’t bring eClinicalWorks in. We had a primary care doctor who was using it so we looked at it. It wasn’t geared well for ENT. It was more for a (general) medical practice. The hospital was going to give us a discount with eClinicalWorks, but we didn’t like it well enough to jump into that,”stated Dr. DeMoville.

Meaningful Use Carrot

Dr. DeMoville also considered an EMR that was being developed by a Memphis physician. “We were almost ready to buy his system, but it didn’t meet the federal requirements yet for Meaningful Use. He said he’d have it by January, but he wasn’t sure. We told him we were looking at WRS and he said, ‘If you are not taking mine, that’s the next best one to take. They are already up to speed and it’s good.’ WRS ENT Electronic Medical Record made it easy to meet the criteria for MU and WRS was set up to have the data available to push the buttons to pull up reports that I needed. It went very smoothly. We got our first check a month ago. That was a pleasant surprise.” said Dr. DeMoville in his review.

Cloud Connection

So, how smooth was the transition to WRS ENT Electronic Medical Record? “It was a nice transition to a cloud. We can access it anywhere. We couldn’t do that before unless we were set up in our office and had our servers running. If you get calls in the middle of the night you can pull up your notes or your partner’s notes. If one of his patients calls you and says, ‘I had surgery and I need more pain medicine,’ if I didn’t have web-based EMR to pull that up… a lot of people call for pain medication in the middle of the night, our response used to be, ‘We don’t do that. On the weekends you have to go to the ER.’ But now I can pull up and verify, yes he did have surgery, it’s a realistic time frame from when he was given his last medicines. It’s a nice thing for patients. It improves patient satisfaction,” said Dr. DeMoville.

Dr. DeMoville continued, “If a patient is primarily seen at one of our other offices, we used to have to fax the notes. The system was not web-based so you couldn’t just pull it up. When we had the other system, the notes weren’t always there or they weren’t always completed. Now you can at least verify, yes they were seen. Even if the notes are not finished, you can see the note in progress or where they are with that note and verify that they were logged into the system.”

Have it Your Way

Noting in his review that Dr. Lee “takes a laptop from room to room” and uses WRS ENT templates for all of his notes, Dr. DeMoville said, “He loves the templates. At the end of the day, he says, ‘I’m done. I’m gone.’ You can use templates as much as you want. For people who love that, that’s a great thing. I’m using Dragon Dictation. I have some templates for some specific treatments that I do. I like the templates for procedures and operative things. There are several templates that work well for me. The whole note is useful. As far as templates, you can develop your standard protocol for follow up postoperative visits.”

Built-in Post-op Efficiencies

Pointing out that he performs ear tube procedures on children, Dr. DeMoville said, “Every time they come in for the postop visit, these are almost the exact same thing. You have a template note, so when you get done, you’ve looked at the child, you’ve looked at their ears, everything is basically normal 90% of the time, so the note is always the same. When you pull up the post-op note, there’s a button you push for template; it pulls up whatever post-op note you want. For that visit, a few seconds after you see the patient, the note is done. Those types of ‘predone’ notes for the routine follow-ups that are always the same are very nice to have.”

Noting in his review that he performs CT scans in house, Dr. DeMoville said, “We have a template for that. You have to read the scan and put the answers in, but the template is there to easily generate your note right away. WRS has a post-op note for an office procedure that we use. On the various types of notes, there’s a button to click to say what type of note it is. WRS ENT Electronic Medical Record has an allergy testing note, various ENT type notes, and some questionnaires, such as a dizziness questionnaire. Those are nice to have.”

This is How You Do it

Knowing that Dr. Lawrence Gordon, an ENT, developed WRS was reassuring to Dr. DeMoville. “It was one of the things that drew us in. It’s helpful that somebody who does what we do has already done this,” said Dr. DeMoville. He was also very impressed with WRS one-on-one in person training. “Resa came out and did our training. She’s very good and very personal and I enjoyed her teaching methods. We were in a big rush to get this done. We wanted to make the MU (deadline).”

Tutorials are King

Dr. DeMoville also raved about WRS tutorials. “Everybody sat down and watched. It was very helpful. As happens in most training, you get a page or you get a call and you say, ‘I wasn’t really listening.’ So you go back to the tutorials, which I did. They were very good. When anyone says, well they talked about that but…I say just click on the tutorial and they are as good as what they told us or better because you can go back to it and go over it. The tutorials are very well done for almost anything you want to do. For instance, WRS has a very nice tutorial that tells you about templates and how to create your own templates. Those tutorials were well thought through. I found it very simple to listen to it and to do it. If you take the time to look, it’s there. You just have to listen to it and it’s explained quite well,” said Dr. DeMoville.

Not Singing the Billing Blues

Now that Mid State ENT uses WRS Billing Module, the staff doesn’t have any complaints. “I haven’t had my staff come and say, ‘This is bad.’ I haven’t had my billing people coming to me complaining about anything. MU went right through. We didn’t have any issues with MU at all. We sent MU, it was accepted and done. That’s a positive,” said Dr. DeMoville.

Educating Patients

While Dr. DeMoville credited WRS Patient Portal with enabling him to meet MU criteria, by sending educational information to patients about their condition, he is finding the capability is helping to enhance patient care. “There’s a place where you enter a certain diagnosis and it kicks out an email to patients about the places to get information from. That’s built in WRS. We were using it initially (to qualify) for Meaningful Use. It made us wake up and look at it and say, ‘Oh it’s here. All we have to do is just push and it automatically sends this information so we know we can mark in a box, yes that’s done and it’s a track record to show that it’s done. We picked the most common diagnosis we already had information for and it was already right there. That was helpful.”

Paper Control

Paper is passé. Just ask Dr. DeMoville. “We use WRS Fax Queue a lot. The advantage is paper control in your office. We were inundated with faxes all the time. You get five copies of the same patient. Did I mark that one off yet, sign that yet? You put it back in the chart and I signed five of them. And the office staff would be going nuts and filing them. Now the fact that we have a nurse divided between the doctors who says, ‘That’s a Dr. Lee patient, that’s a Dr. DeMoville patient’ and puts it into my queue and a couple times a week I go through my stuff and click on it and move it and it gets into the chart. It’s still a safe way of doing it because it doesn’t go into the chart until I say it’s completed. And I don’t have a stack of 100 papers on my desk. It’s paper control. I like the fax queue a lot. We have all the Rx data, all the pathology data. All of that comes into our queue,” stated Dr. DeMoville.

The Virtues of E-Prescribing

Dr. DeMoville reports in his review that WRS e-prescribing capability is a win/win for physicians and patients. Patients will say,’ I’m waiting on my script,’ and I say, ‘It’s done.'” It’s there at the pharmacy,” said Dr. DeMoville.

Explaining the benefits to physicians, Dr. DeMoville said, “You also have a list of medications that were sent from our office. It’s good to have all of that data at your fingertips wherever you are. You click on the medication. It keeps the history of how you prescribed it. You may prescribe it five different ways for different weights, or sizes or age of people, but you can click on what you are going to prescribe and it has your history of how you did it. You don’t have to calculate it each time. If it’s for a child, you click on it and it’s there all the time. Once you’ve done it a few times, it’s keeping a record of how you are doing it and makes it easier. We have tried to e-prescribe in the past and it was laborious. Now that it’s built in and right there, it’s easy and it’s nice.”

Dr. DeMoville added, “I also have the history right there with the script. If a doctor didn’t write it down and hands you the script, it’s not in there. If you e-scribe, it’s there all the time. It’s much better when they call and say, ‘you gave me this antibiotic’ and you say, ‘which one?’ and they say, ‘I don’t know, I don’t remember, it was a red pill.’ Maybe I didn’t write it on my chart for some reason, and I just wrote the script and handed it to them and got sidetracked. If I did e-scribe it’s always there. It helps with efficiency and security.”

Having WRS e-prescribing capability also alerts physicians to possible drug/drug interactions. “The interactions pop up; you can bypass it if you want or look at that and say, I didn’t know it did that. That’s great for safety,” said Dr. DeMoville.

Price Points

So, how much does it cost to obtain a state-of-the-art Electronic Medical Record and practice management system? “We thought WRS was quite reasonable. It was certainly a lot cheaper than eClinicalWorks. It was less expensive than AdvancedMD and that was a disaster. The fact that it made it easy to get our money back from the government, made WRS even more reasonable,” said Dr. DeMoville in his review.

Referrals Made Easy

Sending referrals to physicians is a breeze. “I send them a note with my impression and my plan and a thank you. That populates from my note. That comes from just pushing a button and it pulls the stuff out. I like that,” said Dr. DeMoville.

Charts at Your Fingertips

When asked to name what he likes best about WRS ENT EMR, Dr. DeMoville couldn’t limit his answer to just one thing, “The best thing WRS does for me is it’s easy access and ease of retrieval without having to have someone go find a chart that might have gotten moved between offices. That’s always a pain. Someone is going to see a patient, I need his chart. So somebody takes the chart up to the other place and then it’s not in your office, and I have to ask, ‘Fax me the last few notes.’ That’s never a problem; the data is always in front of you. It’s a good thing. One very nice thing is when I see a patient, the next time I see that patient in follow-up that physical exam repopulates in my note, so I just have to put the changes of what has happened since I saw him last. That saves time. I love the program. I love the software. The whole thing works well. It’s easy to navigate. You can pick it up pretty fast. Initially, like everything else when it’s new, my staff said, ‘We’re never going to get used to it.’ But once they get used to it, it’s good.”

Staying Put

So how did Dr. DeMoville and Dr. Lee become partners? “Dr. Lee was my junior resident in the Navy. We both grew up in California. We both went all over the place with the Navy. I did my last duty station in Pensacola, Florida. He was in Okinoaw and he came and took my job. I went into civilian practice in Alabama. It was a small town. I did well but it wasn’t my favorite place to be. He came out and joined this practice 14 years ago and the following year he gave me a call. They had a doctor who was retiring. They wanted someone they knew. I was already thinking about it so I took it. I love it. It’s a great place to live. Hendersonville is 13 miles out of Nashville and Gallatin is about 20 miles. We’re a bedroom community. The towns’ population are 40,000 to 50,000 each. There are several small towns around that we draw from. We’re separated from Nashville by the Cumberland River, which makes it a nice little barrier. We’re referred to by six or eight little towns around us. Nashville is very nice area. It’s a melting pot because it’s Music City so you have people from all over the world, all over the country who come and live in the area,” said Dr. DeMoville.

Storm Proof

Living in a geographical area that is prone to tornadoes, you can’t help but wonder whether Dr. DeMoville ever stays up at night worrying about his system crashing. “Tornadoes come through this little town of Gallatin. In the last three years we’ve had a couple come through that were very impressive. We didn’t lose WRS. When the Northeast had Super Storm Sandy, we thought we were going to lose WRS. We had it the whole time. We didn’t lose anything. In that kind of weather it was nice to know. We have a storm coming through now. We haven’t had any issues. I have WRS in front of me. It hasn’t quit,” said Dr. DeMoville.

Dance to the Music

When Dr. DeMoville isn’t seeing patients, you’ll find him taking advantage of his proximity to Nashville to enjoy the music. Does WRS allow him to be a concert goer more often? “I think it will. For me initially it was labor intensive because I was trying to type and I’m not a typist. I like my note to look unique to the patient. I want it to be real. I like the aspect of being able to use Dragon Dictation. It dictates my initial history impression, history of present illness and my plan. I’m a combination person. I love the templates and I use them. I’m very happy with the system. I think my notes are better,” said Dr. DeMoville to conclude his review.