 A wall of charts in a physician's office. Most practices maintain up to 5,000 of these. Folders filled with patient data were a burden for decades, but now physicians such as Dr. Alan Oki are abandoning the space-hungry paper records. We had half of this file cabinet here. This was entirely full, and we had both sides of this cabinet here. And we've given up all of that, and we're down to two sides of this cabinet. And we should be done with this, scanning this set of charts by the end of the next two months. Come on in here. We'll take a look at our charts for shredding. These are charts that we've scanned over the past two months. And there's some more over here. And we should be... We'll have a nice little scanning shredding party that is in the next couple of months. So, Laurie, how much work is it roughly to put one chart in in terms of how much time it takes and how do you organize all that information electronically? What I'm doing now is I'm actually prepping and making sure everything goes in the right file. It depends how big the chart is, I guess maybe about five to ten minutes to prep it. And then to scan it is like maybe three to five minutes. Since Dr. Oki implemented an electronic medical record system, or EMR, he and his staff transfer 30 to 40 charts a day onto hard drives. Oral mucosa is moist and without ulceration. Dr. Oki found that electronic records allow him to complete his exam notes during and not after the encounter. He learned how to use the dictation module, which saves him not only time but money too. When I was transcribing every note, it was costing me $30,000 a year. So, I felt that I could... once I had the EMR working and I could drop my transcription costs and that would pay for itself. And in fact, that's the way it's worked out. I think that we're in fact saving money. When Dr. Naomi Akita and OBGYN decided to open her practice in Mililani, she avoided charts from the start. She is using an EMR system over the internet that manages front and back office as well as documentation and billing. It's just a lot more efficient. You don't have to waste time with someone, you know, looking for the chart, filing the chart. The MAs walk into the office and everything's ready to go. They just turn on the computer, all the patient's information there. When a patient calls in, they can just pull up the patient right there, do a telephone encounter and just communicating with the patients. It's a lot easier and a lot quicker. Dr. Akita likes to enter exam notes on her laptop. In fact, she's never without it during office hours and she finds typing and talking go well together. Basically, I use a laptop and I type, you know, the HPI while I'm talking to the patient and I maintain eye contact and the patient has no problems. There's no different than writing in a paper chart and it actually improves patient satisfaction because you're spending more time talking to them and less time charting. Doctors Okita and Akita learned that the transition to electronic medical records was accomplished with their staff's buy-in and appreciation of the benefits. Well, you know, after we get everything in, all the information, and then I think it'll be much easier, you know, because we have patients coming in and then, of course, new patients. You know, then you always have to enter all the info. Medicines. Yeah, the list of medications and stuff like that. Once they're established, patients, then it's easier. You just take down their vital signs, allergies, and medications. I don't have to worry about how I spell medications or what kind it is because it automatically is already in the computer and as far as getting refills done, there's all the pharmacies already in the computer so we don't need to necessarily even call in the pharmacy. We can just look up in the computer and then send it to them via email or fax. So it's pretty easy as far as that goes. Initially, I think any office will have some reservations about moving into a new mar because it's a lot of work. We went through several full half days of training with the entire staff. We didn't have any downtime. We were, we started up, we had kind of a difficult week and the second week we were right there seeing the same number of patients and ripping these notes and handling it. Frank Diaz was part of a team that developed an EMR for the U.S. military. Now he's guiding over 30 independent practitioners in Hawaii through the EMR jungle. Make sure that you have the right templates. A dermatologist has certain templates that he works with. Same with internal medicine, same with say you do a lot of workman's compensation. You want to get that as customized as possible and most of the vendors now do that. They'll deliver 20 templates and then you can just modify them a little bit and it'll cover 90% of your work. I have a UTI template and for basic things that aren't complicated if you have a template for it because you can just put all the tests you normally order, your assessments. It keeps track of how you manage things and then you can just click on the button and it'll show you all the ways you've managed it and you can just click on it because you usually manage it pretty much the same way every time. His system's way of handling notes prompted Kaimuki Internist Dr. Cyril Goshima to change to another EMR. I think the main thing for me is that we do have templates that make it easier for you to do record keeping and doing your notes. I think the current system I have, it's difficult to do templates and note keeping so I do a lot more typing than I would like to do. Examination colon. Mrs. Jones is a well-developed nurse lady. Whether a physician chooses to use dictation to increase efficiencies or templates depends on preferences and the dedication to set these tools up for daily use. But the initial customization efforts seem to pay off. It's more than worth the effort because the system just improves your efficiency, there's just no going back. I think it's worth every penny and I would... If I couldn't get this system to work I would definitely be getting some system to work for me because it's just is such a vast improvement over paper. So it's not a matter of whether you want to do it or not you're going to have to do it. So it's a matter of when you want to proceed and do it. If you look at all the incentives that are being given now Hawaii Independent Assistance Association has an incentive. Tax credits, software hardware, it's sort of like an IRA. If you put in 5,000 now in five years from now you'll have a lot more money. The same thing with this type of thing. We found that the first year you lose money, the second year you catch up, the third year you start making money. That tends to be the way. So wouldn't you rather start that timeline now than later? Eliminating paper charts and all their shortcomings is just one major advantage of electronic medical records. The system's long term pay off will likely include better care and less time spent in the office.