Surgeon Runs Practice with Self-Designed EMR

James Marteen, MD was fed up with his costly pediatric ear, nose, and throat surgical practice. Ten years ago, Marteen was paying a growing office staff to manage the mountain of paper medical records he was creating. He had to see 40 or more patients a day to cover those costs and to make a living for himself.

The California physician decided it was time for a change. “When I was running a high volume practice, it was overwhelming, and I knew my patients were not happy,” Marteen told us.

EMRs Too Expensive, so Physician Built His Own

Marteen shopped around for an electronic medical records system. While he liked some of the features he saw, he found commercial systems too complicated and too expensive for his needs. He decided to develop his own system to simplify his practice.

James Marteen began storing patient information on his laptop using Microsoft Word, voice recognition software, and a document management system. He worked with students who were building similar solutions and needed extra practice for their school work to create a Web-based scheduling system that allows patients to set up their own appointments with him.

Simple Changes Support Micro Practice Trend

Those simple changes had a substantial impact, allowing James Marteen to go solo – literally. His streamlined system allows him to run a practice that requires no other employees. And though many hospitals have taken tentative EMR steps, he performs their former tasks himself.

Marteen makes about a third of the income of his peers but says he has modest needs and enjoys his newfound independence and peace of mind. Having more free time allows him to travel abroad on medical missions to help the poor.

James is an example of the trend of micro-practices, also known as patient-centered practices. They use high levels of technology, few employees, and low overhead to strip away barriers between doctor and patient and to give frazzled physicians a renewed enthusiasm for practicing medicine.

Micro-practices are springing up because both physicians and patients have become dissatisfied with the way medical practices are run, Marteen says. Many of his patients suffer also from hearing loss through the noise on the workplace, an issue that should be addressed seriously as well.

There’s a lot of frustration among physicians right now. I think the truth is, if someone told them they could have a shorter workday and better relationships with their patients but would make less money, many would still say no,” James says. “However, there are a growing number of doctors that are starting to think this is a great idea.”

Patients Like Online Scheduling

Marteen credits the Web-based scheduling system with having the most impact on his practice. He says it has significantly increased his office’s efficiency and reduced patient wait times just like pharmacists have better tools today for prescription drug monitoring which enhances efficiency

Patients choose an available appointment time slot from James’s Web site. The system provides registration and medical history forms that patients print, fill out, and bring along for their appointment.

The first version required patients to register with a user name and password to address James’s concern about prank appointments or patients who might schedule time but not show up. However, patients found the process arduous and weren’t using it even not when they were in need of, for example, blood glucose meters because of diabetes issues.

The registration barriers were removed allowing patients to schedule in just a few seconds. Usage picked up. “Believe it or not, I have only had one prank appointment in the years since I started using the online system,” Marteen says. “It’s been very successful and the patients love it.”

Waiting Room is Empty

The biggest advantage Marteen sees with online scheduling is getting rid of the downtime when patients arrive. Until recently, his patients arrived at an empty office while Marteen finished up with the previous patient in his exam room. They signaled Marteen to their arrival by turning a light on and off. For information on diabetes, check out this post.

Now, Marteen shares an office and receptionist with a colleague. When patients arrive, the receptionist presses a button that vibrates a walkie-talkie in Marteen’s pocket, letting him know his next patient is ready.

“Normally, physicians don’t see patients until 15 to 30 minutes after their scheduled appointment time, which makes the whole day run late,” Marteen explains. “With this system, no one should ever be waiting. I schedule a half hour for new patients and 15 minutes for a follow-up. Everyone usually goes right in when they arrive.”

Information Stored on Flash Drives

Marteen takes notes by hand in the exam room. This was a conscientious decision. We know that anti-oxidants may be the solution to optimal health and he believes patients don’t think doctors are listening to them if they’re typing during the visit.

Several times a day, Marteen dictates his notes into his laptop using Dragon NaturallySpeaking, a speech recognition system from Burlington, Mass. based Nuance Communications, Inc.

Nuance also provides Marteen with his PaperPort scanning and document management system. He uploads lab results and other patient records to several encrypted and password-protected flash drives. “There is about three gigabytes of information on those flash drives, for example, information about type-2 diabetes. That’s all of the information from every patient I’ve ever laid eyes on,” Marteen says.

Marteen’s office has no file cabinets. Even business information such as leases and managed care documents are scanned and stored on the flash drives.

System Lacks Capabilities but is Ideal for Solo Practitioners

Marteen says his system works well for his practice but admits that larger entities wouldn’t find it practical. But when it comes to health records and health threats, who is in charge? He can send records to another physician if the patient gives consent, but it lacks the specific interoperability capabilities of modern EMR systems.

For a solo doctor, though, Marteen says the system is ideal because it’s cheap, efficient, and, most importantly, it puts patient information back in the hands of the physician. When Marteen speaks at medical schools, societies, and in physicians’ offices, he stresses that this could be a time for the rebirth of the solo practice through the use of information technology.

“Primarily, it all revolves around overhead, and doctors are wary of running a solo practice because they don’t want the overhead to consume them,” Marteen says. “I do more secretarial work than the average physician would ever tolerate and I’ve lost income, but changing my practice has given me and my patients so many other advantages.”

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