Imaging Offers Efficient Path To EMR

Electronic medical records (EMR) have become a hot topic over the past few years. First, we saw HIPAA privacy regulations force medical practices to consider digitizing documents for auditing purposes. However, the “P” actually stands for “portability,” and recently we’ve seen a lot more attention given to that aspect of EMR. Even President Bush, in his annual state of the union address, encouraged the adoption of EMR to improve efficiencies.

But do all EMR applications accomplish this goal? SRS Software CEO Evan Steele doesn’t think so. As evidence, he points to National Health Information Technology Coordinator David J. Brailer’s estimation that 30-50% of EMR installations fail. “Most failures are caused by medical practices trying to transition to electronic records from paper-based ones,” Steele told DIR. “When you start asking medical personnel to do point-and-click-based data entry, it becomes cumbersome, especially for physicians seeing a higher volume of patients.”

According to Steele, these “database”-driven EMR applications are targeting a problem that doesn’t really exist. “There never was a problem with how medical records are written,” he said. “The problem has to do with access. A document imaging-based system [such as the one offered by SRS] addresses the access problem without disrupting traditional note taking processes.”

From Humble Beginnings…
Steele co-founded SRS in 1997, along with his brother. At the time, the former investment banker with an MBA was managing his brother’s pediatric ophthalmology practice in the New York City area. “I helped grow his practice from one to multiple offices throughout the area,” said Steele. “While I had great management experience, I didn’t have any experience managing medical charts and the paperwork associated with them.

“We had an intractable problem with patients showing up at one office and having to have their charts brought over from another office. My brother likes to tell the story about receiving a diagnosis from his doctor that one of his shoulders had become physically lower than the other. This was caused by literally having to carry a bag around with 50-60 charts in it.”
For those of you not familiar with the health care vernacular, a chart is basically a folder containing all of a patient’s historical paperwork. This includes insurance forms, doctor’s notes, lab results, referrals, prescription information, etc. “Managing the workflow associated with a paper chart can be laughable,” said Steele. “Folders are being pulled, documents are taken out and passed around, people then can’t find documents they need, nobody knows who has them, patients are waiting, physicians are waiting….

“We began using document imaging in 1996 as a way to better manage referral forms, which are very important in my brother’s area of practice. Primary care physicians would fax referrals to our office, but when the patients showed up, often nobody could find the form. We started using a Visioneer Strobe scanner with PaperPort software to scan and index each referral by patient name. That planted the document imaging seed.”

Bar Codes, Medical Workflows Play Key Roles
The seed was watered in 1997, when the Steele brothers hired a developer and began work on the product now known as Easy EMR. Easy EMR uses bar codes to automatically index images of forms associated with patient charts. “When a customer purchases Easy EMR, they fax or send us copies of the forms used in their practice,” said Steele. “We have a proprietary method of recreating those forms within our system. After we install Easy EMR, whenever the user prints a form, it includes a bar code with indexing information related to the patient and type of form.”

Easy EMR is integrated with most major practice management systems, which enables it to automatically capture patient identification information. In addition to storing scanned images, Easy EMR can be used to manage electronically generated documents and graphs. SRS has also designed medical-specific workflows for procedures such as prescription refills and signing off on lab results. “Our understanding of the medical office gives us an advantage over generic document imaging applications,” said Steele. “We are aware of some imaging-centric competitors that have had success in hospital environments, but that is not an area where we currently compete.”

SRS sold its first system in 1998 and began exhibiting at medical practice-focused trade shows in 1999. In 2004, the company enjoyed 102% revenue growth, after reporting 81% growth in 2003. Currently, SRS boasts that its software is being used by more than 2,000 physicians in more than 200 installations.

“Our sweet spot is medium-sized practices, which we classify as having 8-50 practitioners,” said Steele. “Of course, we’ve also had some sales to smaller practices with one or two physicians, who we can get started with a $10,000-$15,000 software investment. One of our largest installations is a Memphis-based orthopedic office with 68 practitioners.”

Because of SRS’ legacy, ophthalmology is one of its strongest specialties. “The paper work and complex processes associated with cardiology, orthopedic, and internal practices make them very good fits as well,” said Steele.

Cheaper And Better
SRS currently relies on a direct sales force of five people along with a VAR channel. When we spoke, Steele said 19 VARs were scheduled to attend an SRS conference this month. The company remains privately funded and is profitable. Steele did not sound overly anxious to bring in additional capital. “We have not done a tremendous amount of marketing to date,” he told DIR. “I’d love to raise a million or two and really try some things nationally; but, I don’t want to get too tied up with venture capitalists.”

In the meantime, SRS is enjoying what Steele considers a unique position in the market. “Our only direct competitor is AIC (Advanced Imaging Concepts), which was acquired by [traditional EMR giant] Allscripts [see DIR 9/5/03],” said Steele. “The problem with that type of arrangement is that database-driven EMR vendors don’t really want to sell document imaging-based solutions. The CEO of one once told me he didn’t want to mess around with $50,000 scanning packages when he could sell higher-ticket, quarter-million dollar [data-driven] applications.”

In addition to being cheaper, Steele likes to point out that imaging systems are better. “For the past five years, we advertise a 100% success rate,” he said. “This means our application has never been pulled out in favor of another EMR system.”

For more information: http://www.srssoft.com