1. CASE STUDY MEDICAL ASSOCIATES CLINIC
D U B U Q U E , I O WA • A M B U L AT O RY S O L U T I O N S
M E D I C A L A S S O C I AT E S C L I N I C I M P R O V E S C O M M U N I C AT I O N
W I T H M C K E S S O N ’ S A M B U L AT O RY EHR S O L U T I O N
AT A G L A N C E Profile Answers
Founded in 1924, Medical Associates Clinic Medical Associates turned to the
ORGANIZATION is Iowa’s oldest multi-specialty group. Today Horizon Ambulatory Care™ ambulatory
it is a complex and busy practice, with EHR solution from McKesson. Horizon
Medical Associates Clinic
141 providers in more than 28 specialties Ambulatory Care combines prescription
Dubuque, Iowa
practicing from 16 locations and serving management, clinical order entry and
– Practice locations: 16 patients in Dubuque and neighboring towns encounter documentation capabilities
– Physicians: 100 in Wisconsin and Illinois. The clinic also to help physician practices eliminate
owns a 40,000-member health plan and mountains of paperwork and operate
– Mid-level providers: 41 operates three joint ventures with a local more efficiently. Medical Associates
– Specialties: 28 hospital. Practitioners log 540,000 patient already uses the Horizon Practice Plus™
visits and write 350,000 prescriptions a year. practice management system from
– Office visits per year: 540,000 McKesson for scheduling, registration
Medical Associates made a strategic and billing. Therefore, adding Horizon
SOLUTION SPOTLIGHT decision to deploy an ambulatory electronic Ambulatory Care was a logical fit,
– Horizon Ambulatory Care health record (EHR) solution in order to enabling the clinic to integrate clinical
maintain its leadership position, according and financial data without making new
– Horizon Practice Plus
to clinic president Mark Runde, M.D. “We investments in administrative processes.
CRITICAL ISSUES are the leader in healthcare in our region,”
– Inefficient communications
he says. “McKesson’s EHR solution gives us “Horizon Ambulatory Care fits our
real-time clinical information, which makes physician workflow,” Schatz says. “The
and workflow
us more efficient and improves patient care modules can be deployed separately or
– Escalating costs due to inefficient and satisfaction.” together, which is critical to our plan to
paper-based processes introduce the new system gradually.”
Challenges
– Increasing volume of paper Results
Medical Associates needed a flexible but
RESULTS
strong clinical solution to quell the overflow To date, with the complete rollout still in
– Projected net gain of of paper. “We stored, photocopied, filed process, Horizon Ambulatory Care allows
$1.7 million annually from and moved about 250,000 patient charts 103 providers in 25 specialties to write
reducing paper, transcription annually, at a cost of $2 million a year,” more than 26,000 e-prescriptions per
services and chart handling, says Brian Schatz, the organization’s chief month. More than 50 providers in 12
and improving the accuracy operating officer. specialties use the Orders and Results
of coding
module, and 23 clinicians in four
It took days for updated information to be specialties are deploying the entire
– $145,000 saved on medical filed in the patient chart. A single chart had system to document and chart all
records staffing within six months to be circulated to multiple caregivers. And patient care electronically.
of deployment; anticipated clinicians had to make decisions with
annual savings of $580,000
incomplete or delayed information. “While “Within the first two weeks of switching
gaining a financial return on our investment a couple dozen physicians to the
– Projected 75 percent reduction was important, our primary motivation was electronic charting system, we saw a
in annual transcription costs to document clinical data electronically to 40 to 80 percent reduction in dictation,”
– More than 26,000 prescriptions improve communication throughout the says Schatz.
per month delivered electronically
organization,” Schatz says.
The clinic spends $1.5 million annually
to pharmacies, reducing phone on transcription services to transcribe
calls and providing better dictated reports. That number will be
patient interaction cut by 75 percent once the EHR is fully

2. CASE STUDY
M E D I C A L A S S O C I AT E S C L I N I C • A M B U L AT O RY S O L U T I O N S
integrated into clinical practice. Horizon phone, and I don’t have to get a piece of
Ambulatory Care allows physicians to paper to write it all down. There are fewer
quickly document patient visits by using steps and fewer chances for mistakes.”
pre-defined templates designed specifically
for their specialty and their individual For Mark Niemer, M.D., the first Medical
“McKesson’s EHR solution gives us Associates physician to use all three
practice, significantly reducing the need
real-time clinical information, which for transcription. modules (Prescription Writer, Orders and
Results, and Chart), Horizon Ambulatory
makes us more efficient and improves In addition, because the software Care’s charting flexibility is important. In
patient care and satisfaction.” automatically documents exactly what addition to typing, he can dictate into the
care was delivered, coding is simpler and recording device and save the file for
more accurate. “We expect to gain at least playback, handwrite notes or drawings,
Mark Runde, M.D. $500,000 in annual revenue as a result of scan in documents or import digital
more thorough data capture and accurate images. Dr. Neimer points out that
Clinic President coding,” Schatz says. Horizon Ambulatory Care enables every
physician to use the chart differently.
From a medical records staffing perspective, “Ophthalmologists may like to draw
the clinic already has reaped a 10 percent pictures of the retina. For a surgeon
savings. When fully deployed to the describing the location of lesions, a picture
entire staff, the system will further reduce is worth a thousand words,” he says.
temporary medical records staffing hours,
leading to a 43 percent labor cost reduction Nurses are enjoying benefits of the
and saving $580,000 annually, Schatz EHR system as well. Medical Associates
estimates. has measured a 26 percent indirect
productivity gain for nurses because they
Ultimately, the clinic expects to see a net are logging fewer hours chasing down
gain of $1.7 million per year, thanks to records, recording information and
decreased costs associated with staffing, calling pharmacies. Because they are
transcription services and chart mainte- more productive, nurses are able to
nance, as well as increased revenue from spend more time interacting with
better coding. patients and their families.
The staff ’s reaction to Horizon Ambulatory With Horizon Ambulatory Care, Medical
Care has been overwhelmingly positive. Associates will be able to use clinical
“The greatest gain for me is having instant information to drive an evidence-based
access to information that I can act on practice model. “We can build in health
quickly,” says pediatrics chief, Douglas Olk, maintenance alerts and perform
M.D. “If the mom of a child I saw two days population-based analyses to determine
ago calls to say that he’s throwing up his how well we care for our most common
medicine, I can call up the encounter diagnoses,” Schatz says. “That’s going to
instantly, change the medication and give us more quality management tools,
send the prescription to her pharmacy to which is exciting. In a paper world, you
be ready when she arrives.” just couldn’t get there from here.”
Horizon Ambulatory Care has also helped
Dr. Olk streamline his office routine.
“While I’m in the room with the patient, I
can order tests, submit the order, and I’m
done, Olk says. “I don’t have to come out,
McKesson Provider Technologies interrupt the nurse who’s busy or on the
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