The Paperless Physician

October 2nd, 2006

The Daily Camera (Boulder, CO)

A visit to Gastroenterology of the Rockies in Boulder might seem different than most trips to the doctor.

The reception desk is free of stacks of file folders, nurses measure blood pressure without writing it down, and instead of clipboards, doctors carry small digital devices.

This streamlined, paperless environment was part of Dr. Joel Montbriand's vision when he started the practice in 1994. To accomplish his objective of high-quality care with more time devoted to patients than paperwork, he knew he needed not just innovative medical practices, but innovative business practices as well.

Montbriand's pioneering medical business model earned him an Ernst & Young Entrepreneur of the Year Award for the Rocky Mountain Region this summer in the category of health care and life sciences.

"I was very proud and honored," he said. "I think the reason they chose us was they were really excited to see a medical practice take the best out of other industries."

Mark Siegel, director of the program for the Rocky Mountain region, said the independent committee looks for six qualities in its honorees: entrepreneurial spirit, financial performance, strategic direction, community impact, personal integrity and innovation.

"I think Dr. Montbriand really exemplified the innovation criteria," Siegel said.

As senior partner, chief executive officer and chief operating officer of Gastroenterology of the Rockies, Montbriand's emphasis on technology and customer service has enabled him to expand the practice to include nine physicians and state-of-the-art endoscopy centers in Boulder, Longmont and Lafayette.

Gastroenterology involves the care of the gastrointestinal tract and the treatment of disorders in the tract. Endoscopy is a procedure that allows doctors to look inside the tract.

Montbriand said a main objective was for his staff and patients to have easy, quick access to information. Embracing technology was an essential first step.

The three endoscopy centers are connected by interoffice e-mail, and the doctors have videoconferences via plasma television screens once a week. Patient records are stored in a central computer system that eliminates the paper shuffling that often slows down other practices.

"The whole goal there was to free up the doctors to focus on patient care and to make them more efficient so that they can be more responsive to their patients' needs," Montbriand said.

He said the technology has allowed doctors to not only see more patients, but to spend more time with them, too.

Eliminating paperwork allows him to operate more efficiently with half the staff, he said. He said his physicians are 15 percent to 20 percent more productive, and his support staff is 25 percent to 30 percent more productive.

"It's an amazing time-saver," said Kate Beeman, manager of nursing operations. "Not to mention the accuracy is tenfold compared to paper charts."

From the outset, Montbriand based his business model on practices that were already working for other industries.

"One of my main goals was to go paperless and really start adopting best practices that we saw in the business community to increase our efficiency, to increase our accuracy and to decrease the amount of time that we as physicians spent documenting things on paper charts and chasing after records," he said.

Many physicians aren't focused on the business end of their practices because it's not their expertise, Montbriand said.

"A lot of doctors are so busy being doctors that they don't have time to sit down and understand an area that they've never had any training in," he said. He estimates only about six other private practices in Boulder County use electronic medical records.

"We're pretty state-of-the-art here versus the other places I've worked," clinical nurse coordinator Tara Bernhardt said. "It makes it feel like you're not in the dinosaur age anymore."

But implementing technology is an expensive, long-term investment that many doctors don't want to gamble on, Montbriand said. When he decided to computerize his practice, he took no salary for six months and invested in the best software and equipment available.

Montbriand has adopted business methods beyond technology, too. He stresses the importance of employee training and recognition, community presence and a strong, content-based Web site.

Part of his marketing strategy has been to educate the public about colon cancer. His practice participates in the 9Health Fair and has held a "colonoscopy party" for female patients, who were treated with facials and massages before the procedure.

Montbriand also founded Medamorph, which currently provides billing, information technology and human resources support to Gastroenterology of the Rockies. He plans to expand the venture into a consulting company for other medical practices.

Montbriand said he reads business books and will continue to stay up-to-date with new technologies.

"I'm constantly educating myself on the business of running a practice," he said.