Anniston Orthopedics and Greenway Medical Technologies

Anniston Orthopedic Associates, P.A. (AOA) is a surgical group comprised of six physicians who provide services to the Calhoun County area of Alabama. As of mid-2012 the group had not updated its information systems for several years. When the federal government initiated a program to incentivize medical practices to migrate to electronic medical records (EMRs), the group's physicians realized that it was time to upgrade their systems. To transition from paper to EMRs, AOA had to implement a system that would encompass hardware, software, and an upgraded network. After considering numerous vendors, AOA selected Greenway Medical Technologies' Prime Suite product as the group's new information system. Arriving at this decision was only the beginning of the process, however. To run the Greenway Prime Suite software, AOA had to upgrade the group's IT infrastructure to match Greenway's requirements. To accomplish this task, AOA hired IT consultants to install new hardware and set up a new network. This network brought many needed upgrades, including interoffice e-mail and shared calendars. The staff adjusted well to these changes. One major challenge involved moving patient data that was typically recorded on paper charts, such as demographics and vital signs, into an electronic format. AOA selected third-party software solutions from Chart Capture, Phreesia, and Mid Mark to collect and format medical information so that physicians could review it electronically when they were meeting with their patients. Chart Capture captures data contained on paper charts for AOA. It then displays images of thesed documents in an intuitive format to provide the physicians with access to historical records. Phreesia is a check-in mobile kiosk system that collects demographic and payment information such as copays, conducts medical questionnaires on wireless touchscreen tablet devices, and enters all of this information into the Greenway Prime Suite software. Mid Mark provides machines that measure and record vital signs such as blood pressure, heart rate, and temperature and then enter these values into discrete fields within the Prime Suite EMR. Physicians use speech recognition technology within Prime Suite to complete their medical records for each patient visit. In addition to upgrading their hardware and software to implement Greenway's Prime Suite software, AOA had to train their physicians and staff to use the new system. To speed this process along, Chad Prince, the group's business administrator, attended a week of intense training on Prime Suite. He then presented this information to the practice. All of the training sessions and upgrades were conducted to prepare the physicians and staff for a phased implementation that would consist of two separate "go-lives." One "go-live" would involve the "practice" side of the office, which involved capturing patients' demographic and insurance information. The second go-live was directed toward the "chart" medical side of the practice. This second implementation would involve a full transition to EMR. By mid-2012, AOA had organized all of its internal work flows around EMRs. The company is now in the process of training its staff. Two physicians will begin operating on the new system in April 2012. Two more physicians will join the system in June, and the final two in August. This gradual approach will give the AOA staff time to adjust to the changes. In addition, the trainers can work with fewer physicians during the training and go-live process. As you can see from this case, the process of acquiring new information systems can involve much more than a simple purchase decision.

1. Would acquiring a new information system for a small organization be a longer or a shorter process than acquiring one at a larger organization?

2. Why did AOA pick three separate vendors to help implement Greenway's Prime Suite software application? What are the problems associated with managing four vendors to implement the group's switch to EMRs? Should AOA have purchased a software application from a company that would manage the entire process? Why or why not?