VIP Net Case Studies:

Orthopaedic practice goes paperless from the ground up with VIP.NET

With a fully integrated electronic practice management system, Neville Strick and his colleagues run a thriving “almost virtual” orthopaedic surgery practice with minimal overheads and maximum flexibility.

Indeed, set free of paper file constraints, Waikato Orthopaedics can operate across a much wider geographical footprint than would have traditionally been possible, with a Hamilton base, and clinics in Thames, Cambridge and Hamilton.

Everything goes digital

With Houston Medical’s VIP.net in place there’s no place for any paper in the practice. “Any document that arrives in paper form gets scanned into VIP then shredded. Faxes never get printed out, they’re just redirected within our system; and things like subsidiser charges and prescriptions are electronic in the first place.”  Once a document is in VIP it’s accessible at anytime and anywhere.

Streamlined processes deliver vastly improved efficiency

Consultants and admin staff can access everything they need whether they’re in at base, at a remote site, or even when they’re overseas.  At any time you will be as likely to find Neville doing his “paperwork” in a cafe, or in the car while waiting for his daughter’s ballet practice to finish so with two part time staff supporting three busy surgeons there are substantial savings.

The efficiency gains have a direct effect on Neville’s home life as well as his practice.

“In the 10 minutes between theatre cases, I can have all my records work done and with a few clicks can produce a brief info sheet for the patient to take home including subsequent appointment times, stitch removal, information about their specific condition and the discharge letter to the GP which includes prescription and brief findings of surgery.  Also work certificate for the patient, needed for ACC claims, and I can bill the subsidiser, all complete.

Similarly, Neville has his anaesthetist generate scripts while Neville’s operating. These get printed and given to the patient on discharge, and the patient’s GP can virtually immediately get a copy (via Healthlink) so if, for example, there’s an error in prescribing the GP can do something about it, without the delays and possible errors creeping in through the old manual process of dictation, transcription, printing and posting.

At the same time, with VIP’s “copy-to” facility, all correspondence has interested parties included, so Neville can send the discharge letter to the patient’s GP and automatically have it copied to other parties, such as the patient’s physiotherapist, via email or Healthlink as required. “And I can do all this with only a few mouse clicks. It’s brilliant.”

“After a consultation ACC requires us to produce an assessment report and treatment plan, as well as other documentation such as clinic notes. Without VIP this requires dictation and typing and checking and sending out, which all takes time. With VIP all of the work can be done by the surgeon in under a minute, with no admin staff input”

Facilities such as Memotext, VIP’s automated SMS text reminder service, cuts out even more admin time, says Neville, because it saves staff from having to make reminder calls.

Other functions Neville singles out for praise include VIP’s waiting list system, which allows workflow management, and its sophisticated reporting tools, which allow drilling down into the data to extract information required in ways that would be virtually impossible with other systems.

“There is lots of setting up and this can be overwhelming initially. “All the same, I’d much rather it was this way. Some other systems I’ve seen are far too simplistic. Sure you can learn them easily and quickly but they run out of steam way too soon. With VIP you have the flexibility to do what you want but you do have to put some work in up front to get the real benefits.”

About Waikato Orthopaedics

Waikato Orthopaedics runs Houston Medical’s VIP.net on a single server at its Hamilton base office, while each partner has his own notebook and two PCs are available for support staff use. All devices can access the server either through a local area network at base or via the web.

Dr. George Murell, VIP.NET and Motion Computing

In a unique blend of the old and the new, innovative Australian specialist orthopaedic surgeon Dr George Murrell has worked with Motion Computing’s tablet PC technology to create a cutting-edge paperless medical practice in a renovated old church in southern Sydney.

Dr Murrell is the Director of the Orthopaedic Research Institute at St George Hospital and a Professor at the University of New South Wales, dividing his time between academic work, conducting and supervising research in his specialist area of shoulder surgery with his students and Fellows; and seeing patients.

Several months after leaving all paper and patient files behind in May to move into the teaching practice’s newly renovated premises, formerly Kogarah’s Presbyterian Church, the combination of the old church and mobile modern technology is a total success story.

The beautiful old church was built in the 1920s after its congregation expanded beyond the original next door 1800s building, now also renovated to incorporate offices, medical suites and a café. However its congregation dwindled over subsequent years. Seeing the building for sale directly beside St. George hospital where his research laboratory is situated and close to his day surgery 100 metres away, Dr Murrell and his wife bought the church as a shared premises for both his practice and her dermatology practice.

A former Oxford University Rhodes Scholar, Dr Murrell’s commitment to leveraging mobile tablet technology continues his medical and academic career’s innovative and forward-looking approach, which has seen his team win over 30 international medical awards, with his fellowship program attracting surgeons and patients from around the world.

The Challenge:

The challenge for Dr Murrell and his entire team was to replace the office’s existing filing system. “Previously patients filled out a pink form on their pain and specific problems. Fellows or students then transcribed by hand onto a green form the patients’ responses on their functions, strength and range of motion. I then reviewed those files with the patient before decisions on surgery or treatment.”

The decision to commit to a 100% paperless office was backed by allowing for no filing space at all in the new premises. “It was difficult for the first week or two but well worth it once we were over that initial barrier. The space we’ve saved from approximately 15,000 patient records, each file nearly an inch thick, has been used for more exam rooms and teaching areas.”

The Solution:

Searching for solutions to support his paperless initiative, Dr Murrell found an Australia review site that was very positive about Motion tablets and which recommended Australian distributor Paul Nowicki at Secure Agility, is an Australian owned technology consultancy.

As an early adopter researching online for both tablet PCs and software platforms, Dr Murrell searched for available Australian software before finding fully integrated server-based solution VIP.net in New Zealand from Houston Medical (.net), which focuses on supporting specialist consulting practices. Dr Murrell made contact in late 2008 with managing director Derek Gower of Houston Medical.

“Derek was great, he provided a high level of personalized service and also provided me with an evaluation tablet for several days so I could test out the technology,” said Dr. Murrell. “When we went ahead, Derek was very responsive; he and Houston’s Australia manager Warren Goertz made several follow-up visits to us. They have been hands-on and provided great service in comparison with larger, more impersonal firms.”

“Systems integration and networking specialists Secure Agility installed the wireless system for us to make sure the tablets could be used everywhere, including our day surgery 100 metres away,” added Dr. Murrell Secure Agility helped with the design of the wireless infrastructure for the project, drawing on their familiarity with organisations where mobility is essential to operations, such as hospital emergency department trolleys and other environments that can’t be constrained by location.

Dr Murrell wanted a mobile tablet solution that all users could walk around with and use flexibly. “The VIP.net software provides drop-down menus, so you’re not keyboard dependent. We have the choice of using keyboards and a docking station, which we have in the teaching rooms.”

Multiple people can now access patient information simultaneously and files cannot get lost as they’re now hosted on the server. Just 100 metres away, the day surgery where Dr Murrell carries out 95% of his operations has tablets plugged into the practice’s wireless network to access records on the server, eliminating the need to carry large files and X-rays down the road.

At any time, several people can be working with the tablets, with patients in the front desk area filling out their information; and staff working in the teaching area. With X-ray facilities also incorporated, the team can view reports either using the docking stations, or on one of two regular PCs with keyboard systems and wide 36” screens, also used to easily see ultra-sounds, reports and images.

Patients receive a tablet upon entry to fill out their form by simply checking a box with convenient tablet input. The VIP.net forms guide patients through questions, prompting them to pick and rank a question about their pain and symptoms. “They get more specific when using the technology, also now we are quickly building pop-up prompts that remind patients to go back, if they’ve skipped a question. On paper forms, many patients wouldn’t fill out all of the information but now we can get more complete forms.”

Fellows now use a tablet version of the previous green forms, with software that can either check boxes or write numbers. This makes sharing and utilizing the information much more convenient and has eliminated the errors often associated with manual data transcription.

The Results:

Dr Murrell’s practice now functions in real time, with improved accuracy and efficiency across a wide range of areas for all medical and office staff. He said, “We collaborate better with patients, viewing and showing them their results on the large screens. The quality of information received from patients is much better and more reliable. Because we don’t have to transcribe it twice, it also saves time for the patient. We also use that same information to send reports and letters back to the patient’s GP, so that information is immediately usable by them as well.” 

Dr Murrell said another benefit was being able to view patient records at home or in remote locations. “I can provide care and access information no matter where I am. In theory I could be in a conference overseas, go to the Internet, see the records and give quick feedback and directions to Fellows or students, who can also look up any data by just logging into their server, without having to come into the practice.”

The practice is now exploring using the technology further in the future, such as showing images, DVDs, and other clips to patients, educating them on what is going to happen with their surgery. Future uses could also include expanded research capabilities.