T Sheets on the iPad: MD Urgent Care's Hybrid EHR

When Thomas Pascuzzi, M.D. opened his first MD Urgent Care clinic in 2008, he sought a fast, easy way to document patient encounters that would also allow him to access the records electronically. Pascuzzi had been using paper T Sheets^® in various practice settings since the late 1990s after completing his specialty training in emergency medicine through the U.S. Joint Military Medical Centers in San Antonio, Texas. Since he was already a self-proclaimed "pro" at using T Sheets, the decision to use them in his Albuquerque, N.M. urgent care clinics was a no-brainer.

"No documentation system I looked at works as fast as pen and paper," Pascuzzi said. "And chances are I can document more quickly with a T Sheet than any other written format."

However, Pascuzzi's desire to view, search and edit patient records electronically led him to adopt a process that would put T Sheets on the MD Urgent Care providers' desktops, iPhones and iPads. Once a MD Urgent Care patient visit has ended, the record is immediately scanned and uploaded to an online documentation management solution. The administrative staff uses a rapid scanner that processes approximately 7-8 sheets per patient in less than a minute. After the file is uploaded, it can be archived, retrieved via a simple search, faxed or edited by having additional pages scanned or electronic notes added to it. The online document management solution supports easy access via an iPhone or iPad as well.

"If a patient's lab results are returned after I've already left the clinic for the day, I can review them on my phone, along with the rest of the chart, while I'm on the go or from the comfort of my home," Pascuzzi explained. "This is a hybrid electronic record solution that works."

Before implementing the documentation and storage process at his clinics, Pascuzzi carefully evaluated two things: the cost and security of the documents. In terms of expenses, MD Urgent Care costs include printing paper T Sheets, scanners, and T Sheets as well as documentation management subscriptions. When Pascuzzi's clinics first opened, the practices were small enough that it simply did not make financial sense to implement an electronic record system. Pascuzzi hypothesizes that he will soon re-evaluate using T SystemEV^® as his clinics grow and the costs of paper and electronic documentation management rise.

As for the documents' security, Pascuzzi ensured that the online solution supports HIPAA compliance. The system uses encryption, secure passwords and access tracking actions to help maintain compliance and mitigate security risks. The system allows the clinic to organize users into groups and to provide different functionality rights to each group.

"This method uses proven T Sheets and readily available documentation management technology, allowing our providers to document quickly and effectively while also making secure records easily accessible at any time," Pascuzzi said. "It's a simple process, and it's a process that works."