1. Microsoft Customer Solution
Healthcare Industry Case Study
Multispecialty Clinic Improves Continuity of
Care with Electronic Health Record Solution
Overview “With Allscripts Enterprise EHR, we now have one
Country or Region: United States
Industry: Healthcare—Healthcare
record for each patient regardless of how many
providers providers that patient sees. That record is updated
Customer Profile
instantly when the patient sees any of our providers.”
Springfield Clinic, based in Springfield, James Hewitt, Chief Information Officer, Springfield Clinic
Illinois, employs more than 1,400 people,
including 195 physicians and surgeons Springfield Clinic, the second largest medical clinic in Illinois, has
who represent nearly every specialty. It has
24 locations across the state. more than 195 physicians and 24 locations. Many of its patients
see more than one physician at various locations, so multiple
Business Situation
The clinic needed to consolidate multiple charts were often created for the same patient. The clinic wanted to
paper patient charts into a unified patient maintain one record for each patient that could be easily and
record that was easy to use and that
physicians could access from anywhere, at securely accessed by providers, at any time, from any location. It
any time. also wanted to analyze clinical data to improve processes. To
Solution achieve those goals, Springfield Clinic implemented the Allscripts
Springfield Clinic deployed Allscripts Enterprise® Electronic Health Record (EHR) system on Motion
Enterprise Electronic Health Record system
and Tablet PCs running on Windows XP, Tablet PCs running Windows® XP, Tablet PC Edition. Allscripts
Tablet PC Edition to all of its locations in a Enterprise EHR, based on the Microsoft® .NET Framework, is easy to
phased deployment.
use and flexible enough to meet each medical specialty’s
Benefits requirements and individual practice styles to enhance continuity of
 Enhanced patient care, expedited results
 Easy accommodation of practice styles
care, increase efficiency, and reduce medical record costs.
 Reduced medical records expense
 Expanded clinical information
 Increased recruiting power

2. “We needed to find a Situation As the number of Springfield Clinic patients
It is no secret that administrative costs play a and physicians grew, so did the organiza-
very lightweight, major role in the high cost of healthcare tion’s Medical Records staff. By 2005, the
browser-based solution today. And much of that cost can be clinic had 160 full-time Medical Records staff
attributed to the sheer volume of paperwork— and 22 file storage locations holding an
that would allow filling out, processing, filing, retrieving, and estimated 45 million pieces of paper. Some
providers to gain access storing millions of pieces of paper. Driven of that paper represented duplicate charts for
partly by the provisions of the Health patients who see a primary care provider at
to our system over a Insurance Portability and Accountability Act one location and specialists at other
standard Internet (HIPAA) governing the standardization of locations. Having the right chart at the right
electronic administrative, financial, and place became a challenge. If a patient’s chart
connection no matter patient data, and partly by the growing need wasn’t available at a new doctor’s site, that
where they were.” to contain costs, healthcare organizations provider would create a new “shadow chart.”
have begun to look at how to convert all of This made it difficult for a physician to have
James Hewitt, Chief Information Officer, those pieces of paper to more easily the full patient record. It also meant that
Springfield Clinic accessible electronic data. Springfield Clinic specialists who visited
outreach locations had to load all the X-rays
Springfield Clinic, headquartered in and charts for the patients they were going to
Springfield, Illinois, is nearly finished with see into the trunk of their car and unload
achieving that goal and has already moved them at the outreach location. Then they had
three-quarters of its locations to paperless to load them all back into the car for the
environments. return trip.
Founded in 1939, Springfield Clinic today has Keeping most of its clinical data on paper
more than 260 medical providers, including also made it difficult for the clinic to analyze
more than 195 physicians and surgeons its clinical data to support quality reviews.
covering virtually every specialty. To respond And it was difficult to create accurate reports
to the organization’s growing patient base, it for emerging initiatives such as the Health
expands by an average of 10 physicians each Plan Employer Data and Information Set
year. The majority of the clinic’s providers are (HEDIS), which measures performance based
located at Springfield sites, including the on important dimensions of care and service,
main campus in Springfield, Illinois, where a and Pay for Performance, which rewards
118,000-square-foot building expansion is healthcare providers for meeting certain
scheduled to open in August 2008. The clinic measures for quality and efficiency. “We had
also operates more than 25 satellite offices done a great job of building systems on the
and outreach locations throughout 12 operational side, but we weren’t able to truly
counties in central Illinois. These offices are mine the data from a clinical perspective to
staffed by local primary care providers and get an objective view of how effective any
offer the services of more than 20 Springfield particular treatment or process was,” says
Clinic specialists who travel to the outreach James Hewitt, Chief Information Officer for
locations several times a month to see Springfield Clinic.
patients.

3. By 2005, the clinic had automated some  Company viability—including their ability
parts of its operations. It used the IDX to support large organizations and the level
Flowcast (now GE Centricity Business) of the vendors’ research and development
practice management system for patient expenditures to ensure that the product
registration, scheduling, and billing. It had a would evolve with the needs of the
repository system from Allscripts that stored industry.
all transcribed patient reports and test  Practical usability—including ease of
results. And it used PeopleSoft for deployment, ease of use, and ease of
accounting, purchasing, and human management.
resources. The clinic ran its infrastructure on
the Windows Server® 2003 operating system The project was made more challenging by
and used Microsoft® Exchange Server 2000 the fact that a majority of Springfield Clinic
for messaging. Both the administrative staff outreach locations are not owned by the
and providers used Microsoft Office 2003 clinic and so were not part of its network
Professional running on the Windows® XP infrastructure. “That presented a major
operating system with Service Pack 2. challenge in our search for an EHR system,”
“Allscripts understands says Hewitt. “We needed to find a very
the complexities of The Springfield Clinic wanted to take the next lightweight, browser-based solution that
step to enhance patient care by implement- would allow providers to gain access to our
various specialties such ing a system that integrated all patient infor- system over a standard Internet connection
as oncology, infusion mation—reports, test results, digital images, no matter where they were.”
and related correspondence—into a single
units, and electronic patient record that was available Based on those criteria, the IT committee
ophthalmology and immediately to physicians in the Springfield narrowed the original list to four vendors.
Clinic network regardless of location. In After closer evaluation, including visits to the
offers the flexibility to addition, the clinic wanted to expedite test vendors and talking to other customers, the
meet those needs.” results and reduce paper handling and Springfield Clinic selected the Allscripts
storage costs. So the clinic went in search of Enterprise Electronic Health Record.
James Hewitt, Chief Information Officer, an electronic health records (EHR) system.
Springfield Clinic “We picked Allscripts Enterprise because it
Solution supports the needs of a large, multispecialty
The Springfield Clinic IT committee, which clinic,” says Hewitt. “It’s a full-blown EHR
included providers, IT staff, and administra- system that allows us to do all of our charting
tive staff initially looked at virtually all the without dictation. Allscripts understands the
EHR solutions available at the time, complexities of various specialties such as
evaluating them based on several criteria, oncology, infusion units, and ophthalmology
including: and offers the flexibility to meet those needs.
 Features and functions—including how Also, it is a browser-based system, which
the solutions integrated with third-party allows us to address the requirements of our
applications, which hardware they outreach clinics.”
supported, and their flexibility to be
adapted to specific requirements of Gaining Browser-Based Access
individual medical specialties. from Anywhere

4. “We wanted to create an Allscripts Enterprise takes advantage of the pilot site because it was the farthest away
Windows Forms, ADO.NET, and ASP.NET Web from the main campus, because one of its
implementation process services components of the Microsoft .NET physicians was a strong champion of the EHR
that could be replicated Framework 2.0 so that users can access all implementation, and because it was very
the Allscripts Enterprise modules through a efficient with paper charting. The location
consistently across our browser. “If providers have a Windows also had a small staff of four physicians and
entire clinic." Mobile® device, they can access our one nurse practitioner.
application through that as well,” says Lee
James Hewitt, Chief Information Officer, Shapiro, President of Allscripts. “The great To prepare the pilot site, the clinic had to
Springfield Clinic thing about being on the Windows operating stabilize connectivity between the main
system is that it allows our clients to access campus and the Hillsboro location and set up
Allscripts Enterprise anywhere they have the wireless network infrastructure. “None of
secure access to the Internet.” our sites had a wireless network so we had to
develop a wireless strategy and deploy that
In addition to the software, Springfield Clinic network in a short amount of time”, says
needed a hardware device that was portable Hewitt. “I can’t emphasize enough the impor-
enough to be easily carried to the point of tance of making sure that your technology
care, yet had a large enough screen so infrastructure is sound, because you’re
providers could clearly read text and view moving all of the processes that were done
digital images. The device also had to be on paper to a very mobile solution where
fairly lightweight and provide at least an everything is now in electronic format.” After
eight-hour battery life. The selected device setting up the wireless network, the IT staff
also needed to support fast performance, installed docking stations for the Tablet PCs,
built-in wireless connectivity, the ability to printers, and scanners.
record dictation, and biometrics so that
providers could log on and write prescriptions Meanwhile, the IT staff installed 12 Allscripts
and orders and sign off on documents with Enterprise EHR modules on two clustered HP
just a scan of their finger. “Biometrics is very ProLiant DL580 G3s and four ProLiant DL360
important because physicians sign hundreds G4s all running Windows Server 2003 R2
of pieces of paper every day, and we didn’t Standard Edition in the clinic’s data center on
want them to have to pen in a password that the main campus in Springfield. All the
many times a day to approve forms,” says information collected through the various
Hewitt. After looking at several vendors, the EHR modules is stored in a Microsoft SQL
clinic chose to deploy Motion Computing LE Server® 2005 database using an HP 5000
1600 and LE 1700 Tablet PCs running the Storage Area Network.
Windows XP, Tablet PC Edition operating
system. The Springfield Clinic IT committee decided to
implement the entire Allscripts Enterprise
Working Out the Details at the Pilot Site EHR suite of products—including Base,
At the end of 2005, Springfield Clinic Document, Dictation, Results, Rx+, Note,
partnered with Allscripts to develop an Charge, Scan, Orders, Analytics, Dragon
enterprisewide EHR implementation strategy. Dictation, and Physician Home Base—at the
It chose its Hillsboro, Illinois location for the same time in the pilot site. “By implementing

5. the full EHR system one site at a time, we charts were available if absolutely necessary
could do a complete reautomation of the but were rarely needed. After two days, the
paper workflows and provide a high degree of Hillsboro physicians and nurses asked that
training and support at that site. After the site paper charts no longer be pulled, and the site
was stable, we moved on to the next site,” was officially declared paperless. From that
says Hewitt. point on, all information and tasks were
handled through the Tablet PCs. Some
The implementation team, consisting of four physicians resumed a full patient schedule
nurses and one technical person, arrived at within two days, and all resumed a full
the pilot site in March 2006. “Because schedule within two weeks. At that point, the
Hillsboro was our first site, we spent a lot of clinic started scanning all the paper charts
time getting the whole process right,” says into the Allscripts Enterprise system.
Hewitt. “We wanted to create an implementa-
tion process that could be replicated consis- Following the successful Hillsboro site
tently across our entire clinic. We also deployment, the implementation team moved
needed to refine the new digital office to each additional site and repeated the
workflows as well as test the entire technical process. By the third site, implementation
infrastructure.” was completed within two weeks. “On
average, each site has been declared
About six weeks before the go-live date, clinic paperless after two days. It is truly amazing,”
physicians started reducing their schedules says Hewitt.
for the week of deployment. Two weeks
before the go-live date, the Education Accessing Many Tasks through
department began training the providers. One Interface
Physicians were required to take eight hours Approximately 1,300 Springfield Clinic staff,
of one-on-one training, and nurses were representing patient accounting, research,
required to take four hours. Then both groups nurses and providers, quality management,
had to pass a test to make sure that they and administrative staff, use the EHR system.
were proficient on the system. On two The patient scheduler can see physician
evenings during the week before going live, availability online through the link between
all the providers and administrative the Practice Management system and
employees at the pilot site ran simulations of Allscripts Enterprise. The nursing staff
patients going through the clinic to work out creates patient charts on the Tablet PC,
process and technical issues. writing notes directly into Allscripts
Enterprise. Then the physician enters further
Bright and early on June 12, 2006, the notes into the chart, orders labs, writes
implementation team flipped the switch, and prescriptions, and creates correspondence.
the system was immediately available to the Physicians dictate into the Tablet PC,
Springfield Clinic Hillsboro staff. They started sometimes while meeting with the patient,
immediately using Allscripts Enterprise EHR and forward those files to the appropriate
on their Tablet PCs for charting, dictating, voice server for transcription. In January
ordering tests, writing prescriptions, and all 2008, Springfield Clinic started pilot testing
the other tasks related to patient care. Paper

6. Dragon NaturallySpeaking speech recognition “Continuity of care is very important,” says
software to expedite transcription. Hewitt. “Now, even if a patient sees multiple
physicians at the clinic, all of those
“With Allscripts Enterprise EHR, we now have physicians have instant access to the most
one record for each patient regardless of how current information from their Tablet PCs.
many providers that patient sees,” says And if a physician on vacation gets a call
Hewitt. “That record is updated instantly about a patient, the physician has immediate
when the patient sees any of our providers.” access to those same records.”
Within the Allscripts Enterprise Physician Springfield Clinic physicians also use
Portal, physicians view schedules, practice- Allscripts Enterprise to instantly communicate
performance data, and medical content. They with hospitals, insurance providers‚ and
also order medications and tests and review pharmacies, which means faster test results,
work tasks that need action such as lab more accurate coding and faster answers
results waiting for review and open charges regarding insurance coverage. It also results
“We caught up with the that need to be finalized. In many cases, in less wait time for prescriptions, and greater
new system within about launching one of those tasks will launch a patient safety.
Microsoft Office program.
two weeks of The increased speed of results initially
implementing Allscripts As of March 2008, the implementation team presented an unexpected challenge for clinic
had completed 28 of its 35 sites. The nurses. Before Allscripts Enterprise was
Enterprise, and in some organization had also scanned 30 million of installed, the nurses always completed all
cases, our turnaround an estimated 45 million pieces of paper into tasks on their desks before they left for the
its Allscripts Enterprise EHR system. day. The introduction of Allscripts Enterprise
times for results went reduced the turnaround time for results
from weeks, to a few Benefits verification and so increased the amount of
By deploying Allscripts Enterprise EHR, work on nurses’ desks. “All of a sudden, the
days.” Springfield Clinic enhanced patient care by nurses had 15 days worth of work in front of
James Hewitt, Chief Information Officer, making it easier for physicians to access a them in the Allscripts Enterprise workflow
Springfield Clinic comprehensive patient record, order tests, portal, and they felt they had to stay to finish
and get results faster. The clinic also was it all,” says Hewitt.
able to configure the system to match
individual practice styles, reduce medical In the transition period, the nurses had to get
records expense, improve clinical processes, used to the idea that the tasks waiting for
and improve recruiting prospects. them came in several days earlier than they
would have with the paper-based system. It
Enhanced Patient Care and took some time to catch up with the new
Expedited Results system, but in the meantime, they were urged
By implementing the Allscripts Enterprise to go home at the end of their shifts. “We
EHR system, Springfield Clinic now has a caught up with the new system within about
single electronic record for each patient that two weeks of implementing Allscripts
is accessible, not only from any clinic Enterprise, and in some cases, our
location, but from anywhere in the world.

7. turnaround times for results went from positions were eliminated in the Medical
weeks, to a few days,” says Hewitt. Records department, were offered other
positions in the clinic, including many new
Easy Accommodation of Practice Styles positions such as scanners and electronic
The rich user interface in Allscripts Enterprise indexers.
made it relatively easy for providers to adapt
to using the Tablet PC–based system. “The By moving to a paperless patient record
rich user interface that we found in the .NET system, Springfield Clinic was also able to
Framework allows us to provide a very rich eliminate 22 file storage rooms throughout its
level of application functionality in Allscripts sites. In some cases, the space was
Enterprise that really wasn’t available with converted to clinical or expanded waiting
classic Web-based applications,” says room space. In other cases, the space was
Shapiro. In addition, because .NET supports repurposed for offices, a centralized
storing large amounts of information in local transcription area, and a call center. In other
memory, providers enjoy nearly instantane- cases, because the clinic was leasing the
“The rich user interface ous response time within Allscripts Enterprise storage space, they were able to end the
that we found in the modules. leases, resulting in an immediate savings.
.NET Framework allows Thanks to the rich user interface, Allscripts Expanded Clinical Information
us to provide a very rich Enterprise is easy to configure to meet the With all aspects of patient care recorded in
needs of individual specialties and match the system, Springfield Clinic is able to
level of application individual providers’ practice styles. “A analyze its processes more accurately to
functionality in Allscripts neurologist doesn’t practice the same way as continue to improve its quality of care. “To do
a pediatrician; even two physicians in the a quality audit with the paper-based system,
Enterprise that really same specialty may not practice the same we had to send out a small army to pull
wasn’t available with way,” says Hewitt. “We’re able to easily charts and do some sampling to see how we
modify the workflow in Allscripts Enterprise to were doing on a particular treatment,” says
classic Web-based quickly respond to the needs of a variety of Hewitt. “Now, we have the entire census at
applications.” practice styles and specialties.” the click of a button and have 100 percent
accuracy across the board on all kinds of
Lee Shapiro, President, Allscripts Reduced Medical Records Expense diagnoses.”
Hewitt estimates that when all of the sites
within the Springfield Clinic are on Allscripts The new availability of clinical data will help
Enterprise, the Medical Records staff will Springfield Clinic supply data for industry
have no more than 60 full-time-employee measurement initiatives such as HEDIS and
equivalents, compared to 160 with the paper- Pay for Performance. The clinic is also using
based system. So far, much of that reduction that data to analyze nonmedical aspects
has been handled through a normally high such as average wait time. “We’ve never
attrition rate in the Medical Records been able to figure out what our average wait
department. “During the months preceding time is because we’re spread out,” says
the deployment of the new EHR system, as Hewitt. “Now, with the click of a button, I can
people left, they were replaced with run a report by specialty, by physician, by
temporary staff,” says Hewitt. Others, whose

8. For More Information clinic, and look at average wait times so we Microsoft Solutions for the Healthcare
For more information about Microsoft can better manage that side of the business.” Industry
products and services, call the Microsoft Healthcare and life sciences organizations
Sales Information Center at (800) Increased Recruiting Power are under tremendous pressure to meet
426-9400. In Canada, call the Microsoft Springfield Clinic also finds the Allscripts regulatory requirements, improve patient
Canada Information Centre at (877) Enterprise EHR solution useful in recruiting care, and reduce the time it takes to develop
568-2495. Customers who are deaf or new physicians. Allscripts Enterprise EHR is drugs and take them to market. To meet this
hard-of-hearing can reach Microsoft text used by more than 3,500 clinics and 700 challenge, Microsoft and its partners have
telephone (TTY/TDD) services at (800) hospitals nationwide and was ranked first in developed cost-effective solutions that
892-5234 in the United States or (905) the KLAS physician satisfaction rankings for enable healthcare organizations to
568-9641 in Canada. Outside the 50 2007. The KLAS Top 20 is an industry streamline and automate daily processes that
United States and Canada, please contact ranking based on service performance and improve productivity and deliver information
your local Microsoft subsidiary. To access results from in-depth interviews with whenever and wherever it is needed. The
information using the World Wide Web, go thousands of providers who actually use result is enhanced productivity, safety, and
to: www.microsoft.com Allscripts Enterprise EHR in clinical practice. quality.
For more information about ALLSCRIPTS “Because EHRs are becoming more and more For more information about Microsoft
products and services, call common in large clinics, new physicians see solutions for the healthcare industry, go to:
(800) 654 - 0889 or visit the Web site at: it as almost a requirement to consider joining www.microsoft.com/healthcare
www.allscripts.com a clinic,” says Hewitt. “Allscripts Enterprise
EHR has such a strong satisfaction rating
For more information about Springfield among providers that it further enhances our
Clinic, visit the Web site at: recruiting position.”
www.springfieldclinic.com
Software and Services  Microsoft Office
 Microsoft Server Product Portfolio − Microsoft Office Professional Edition
− Windows Server 2003 R2 Standard 2003
Edition
− Microsoft Exchange 2000 Server Hardware
− Microsoft SQL Server 2005  Motion LE 1600 and LE 1700 Tablet PCs
 Windows XP, Tablet PC Edition
Partners
 Allscripts
This case study is for informational purposes only. MICROSOFT
MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS
SUMMARY.
Document published May 2008