Visit to a very paperless practice: Michael West, MD PhD – Washington Endocrine Clinic, Washington DC USA

I recently reconnected with Emily Peters (@PFPresscenter), who I asked “How is that Practice Fusion EHR doing?” (she’s the Senior Director of Communications).

I seem to associate Practice Fusion with San Francisco, where the company is based, but I realize that electronic health records, especially web based ones, know no bounds, so I asked if I could shadow in a practice local to me, in Washington, DC. And so I was connected to Michael West, MD, PhD, at The Washington Endocrine Clinic.

If I can walk to it, I’ll do it. So I did it.

Michael West, MD, PhD – click to enlarge

As the name of his practice implies, Michael is an endocrinologist and his practice has been open since 2009. Like so many physicians of his generation, he sought to enter practice without paper. He began with an electronic health record that was physically served within his practice, and then like so many humans in general, sought a system that didn’t require him to be a server technician at the same time he was building his professional career.

Three months in, then, he switched to an electronic health record that’s web-based. The advantage, especially for a physician building a practice, is to not have to worry about maintenance and upkeep of a software package, benefit from the improvements generated by a community of health care practitioners, and also to allow patients to access their data securely.

Michael has a good cadence to his use of the electronic health record. Information about the patients he’s seeing often comes from outside the practice, so it is scanned in or received electronically. What I thought was interesting is that much of the information comes in and goes out via secure electronic fax. In other words, there’s no machine printing out paper on Michael’s end but the protocol is the fax protocol.

Staff at the medical office then downloads the faxed PDFs, renames them, and uploads them to the correct patient file. (“As much as I wish this as an automatic process, we’re not there yet”) The good news is that the information is readable, the not as good news is that the information is not discrete data. There’s now direct lab interfaces to the system, which does populate the medical record.

The result is as the title of this post implies – this is a very paperless practice. I didn’t see much paper moving around, and the desk you see in the photograph pretty much looked like that during the entire session. To my eyes, the patients didn’t miss a beat, I didn’t hear complaints about the use of the electronic health record. In fact one patient said that they like to keep track of their lab values,  which prompted Michael to offer secure access to the information via the patient portal. Again, not a big deal, and this access is seen as a time saver. We’ve come a long way.

The electronic health record itself is steadily improving. I/we noticed there is some functionality that’s not present in this system that is present in other contemporary systems (yet). At the same time, there’s an ease of use and upkeep that’s extremely valuable in this situation.

I asked Michael about two things. First, the fact that this electronic health record is offered to physicians without cost, but with advertising. Second, about the sharing of lab result and pathology result information with patients. Here’s what he told me.

The ads are not really that bothersome.  They are in the periphery and so they don’t get in the way of me viewing the patient’s chart.  Regarding me being influenced to write prescriptions for those drugs, I generally have written those drugs even without being prompted by an advertisement in the EHR, and so I can’t say they have had much impact, if any, on my prescribing behavior.


Regarding patients accessing their lab results, I generally don’t release a specific set of results for viewing without meeting the patient in my office to discuss these in person first.  Pathology results are a different type of result.  Because this is unstructured data at the moment, I cannot release these to patients by using the personal health record (PHR).  Therefore they are either printed or emailed.  If emailing them, then the patient needs to request this and understand that most email is not HIPAA compliant.  If they understand that limitation and are comfortable with that, then I can email it to them.  I would never email patients a pathology report that was not clearly benign unless we had discussed this first in my office face-to-face.

Building a practice takes a lot of work, and I respect a physician who undertakes this challenge, especially today. To arrive at a state of good health, there needs to be enough patient volume and systems that allow people to feel well taken care of. On the particular day I shadowed Michael, he was seeing patients in follow-up, although he obviously does new consults and procedures. As a specialist, he also needs to be responsive to referring physicians, who expect to be notified about his findings in a professional and understandable way.

It’s good for physicians who make this practice choice (still the dominant form of medical practice today) to have the option to coordinate care using electronic health records. Also good to see a new generation of physicians embracing technology in our nation’s capital. Thanks again for having me, Michael, and Emily for the referral!


Ted Eytan, MD