A physician since 1989, Dr. Karen Smith runs a one-physician family medicine practice in Raeford, NC. She credits her electronic health record (EHR) with allowing her to deliver quality care in a rural setting – and to do it so efficiently that she still has time to be a wife and mother. ONC talked to Dr. Smith about how she uses her EHR system to care for her patients—whether she’s working in the office, supervising laundry detail at home, or traveling out of state. She is also one of the providers featured in ONC’s series of print ads highlighting key MUVers – Meaningful Use Vanguards – who have adopted certified EHR technology.

ONC:

Can you tell us about yourself and your practice?

Smith:

I’m a family physician in a very rural, very small community – Raeford, NC. We’re part of Hoke County, which has only five practicing physicians. I have about 4,000 active patients. I’m also very involved in working with the American Academy of Family Physicians to improve health care in my specialty.

ONC:

Do you feel your EHR system has made your life easier?

Smith:

Having a record system that’s organized and easily accessible at any time of the day or night is a major benefit for rural physicians. I couldn’t do my job without it.

Before I had an EHR system, I was staying at the office until 11:30 p.m. every Monday night, guaranteed. I have four kids at home, and I felt like my husband was raising the children by himself. I can still remember the date that my practice switched to an EHR system – it was April 1, 2003. These days, when I get home in the evening, my husband and I can take a walk together at 6 p.m. I’ve done most of my work before I leave the office.

ONC:

How has your EHR system helped you provide better care for your patients?

Smith:

With my EHR system, I’m able to practice and not get burned out. I can review 50 labs on a Saturday while I’m doing the laundry. I review my labs online, and if I find someone who needs to go to the hospital right away, I pick up the phone and call them. If it’s a problem that we need to address within 48 hours, I’ll put an alert message on my system, so that the person automatically gets a telephone call or an email. The message will say that I’ve already scheduled an appointment for them on Monday. And Monday afternoon, that patient will be sitting in my office. So people are getting the services they need, with a much faster turnaround.

Sometimes, being more efficient and providing better care turns out to be the same thing. When I started practicing in this county, I would sometimes receive a call from the emergency room that a patient of mine had been admitted with chest pain, and the doctor there needed the patient’s latest EKG. I’d have to leave my home, drive 11 miles, get the EKG, and fax it over to the hospital. That would take about 30 minutes, while my patient might be having an active heart attack. Now, when the emergency room calls me up, I open up my computer, I click a button, and the hospital gets the EKG within a minute.

ONC:

What are the major benefits of transitioning to an EHR system?

Smith:

For me, the number one benefit of switching to an EHR has been improving the quality of care. I can now pay more attention to the patient as a person, because I’m spending less time trying to document the visit and write everything down. Having an EHR has brought me closer to my patients. They love to email me. They love that type of communication. The second major benefit has been efficiency. We’ve been able to modify the office’s workflow so that we’re able to see more people in the same amount of time. My practice’s EHR has also enabled us to achieve National Committee for Quality Assurance recognition as a Patient Centered Medical Home, as well as heart and stroke recognition.

ONC:

You also have a patient portal to communicate with your patients. Can you tell us a little bit about that?

Smith:

The patient portal allows patients to access their information securely online. The portal allows us to notify patients of laboratory results, schedule appointments, and send out reminders. For example, if I see that a patient’s lab test is abnormal, then I schedule an appointment through the portal and send a message to the patient that they really need to come in to see me. The key thing about the website is that it’s interactive—patients are able to communicate with us, and we can communicate with them.

ONC:

Have you been working with a Regional Extension Center?

Smith:

Yes. Our Regional Extension Center—the University of North Carolina AHEC REC —has helped us tremendously. They are helping us better capture and quantify clinical information, as well as helping us upgrade and get the most out of our computers and EHR system. We originally purchased our computers in 2003, and we’re trying to get the last bit of life out of every computer. The REC has been able to help us do that. And when we make upgrades to our systems, they are right there helping us evaluate what’s best for our practice. They also help us make the right decisions when evaluating vendor contracts. We’ve been burned in the past, but now with the help of the REC, we don’t have to worry about that happening.

ONC:

Anything else you’d like to share about EHRs?

Smith:

As physicians, we’re under such pressure, not only from our patient population but also from our personal lives and our families. With an EHR, I’m able to take care of more patients than I had previously been able to, and not diminish the quality of care for those patients. And I can still live a balanced lifestyle.