Dr. Nathan Littlejohn is a physician and partner at Triple Crown Urology, part of American Oncology Network (AON). He has been with the practice since it launched three years ago. Today, Triple Crown has six locations across central and southwest Arkansas and provides both general urology and genitourinary (GU) cancer care. It's a busy practice—Dr. Littlejohn sees about 50 patients on a typical day, across visits and procedures.
When Triple Crown became an independent practice and chose to partner with OncoEMR three years ago, they were one of the first urology practices to implement OncoEMR. At first, Dr. Littlejohn wondered how an EHR with deep roots in community oncology would fit a urology practice.
Today, he describes Flatiron as a partner in the practice's success; one that is responsive to the ever-changing needs of the urology landscape, and adaptable to the unique preferences of each practice. Along the way, OncoEMR has given his clinicians time back and made it easier for urology and oncology teams to work together on patients’ care.
Below is an excerpt from our conversation.
Flatiron: First, thank you so much for having this conversation with us. We know how busy you are between seeing patients and running your practice! Let's start at the beginning — when Triple Crown was choosing an EHR, what was on your mind?
Dr. Littlejohn: We were coming from a hospital-employed group, so going private meant finding a new EHR. We sampled probably four or five systems before choosing OncoEMR.
Because of its background in medical oncology, there was a little bit of a language barrier at first. We asked ourselves whether we should reconsider an EMR that had stronger roots in surgical subspecialties.
Over time, those language barriers dissolved. It's gotten a whole lot easier for us, and we're in a good spot now.
What turned things around for you?
Flatiron reached out and said, "We now have a team that's committed to making this more user-friendly for surgical subspecialists." They sent a team of people to watch our workflow, boots on the ground. Then they went back, made some changes, and came back and asked, “What do you think about this?” They even made updates I didn't know I wanted.
The open communication, with both sides willing to learn and to work together toward a better product, has been instrumental in our success. I think I learn as much from them as they learn from me. We're honestly glad we stuck it out, because all of us are happy with the way it's working now.
On a busy clinic day, where does OncoEMR help most?
We’re a high-volume, high-output clinic. On our busiest days, across two physicians and three APPs we see up to 165 patients. The less time you are on screen, the more efficient you are, and the more patients you can see.
The most practical thing has been Flatiron’s focus on “less clicks is more.” For instance, the billing screen at the end of the visit has been a monumental improvement. In one screen you create the diagnoses, attach the E/M code, add any modifiers, add-on codes and procedural codes, then connect them with their appropriate diagnoses.You can easily place new orders in this workflow. It's a big time-saver, and a headache-saver.
We go to multiple different hospitals and facilities, but this EMR is home. Having all the documentation in one home has made taking care of people safer, faster, and more efficient.
That time comes back to you. It might mean more patients, or it might mean more time for other things that are important to you, like home and family life, instead of documenting at home or closing charts after hours.
You've described OncoEMR as "malleable." What does that mean to you?
When we first evaluated EHRs, OncoEMR seemed to me to have the best bone structure: a solid foundation of ease of use, good documentation, and good communication, all in one place. And it has proven very adaptable to our needs.
With our old hospital EHR, they didn't ask us for ways they could make it better. We'd just get the update, and whatever they'd chosen is what we'd get.
With Flatiron, there's the malleability of the design, which you can customize for your needs with smart phrases, care pathways, and protocols. And there's the malleability of the software itself. The new patient header is a good example. We talked with Flatiron about how to improve it for urologists, and now you can set it up to show what you want to see. Allergies are right on the header, and your insurance information can be up there too, because that dictates care. They listened, went to work, and came out with things that work well. The openness to change and the ability to change have been such a blessing for our practice.
You share many patients with medical oncology. How does working in one EHR support that care?
We've built a lot of camaraderie with the oncology folks because of how much our patients overlap, and the level of collaboration and communication that caring for them requires. The landscape of care for prostate, bladder, and kidney cancers is always evolving. As it evolves, the line between medical oncology and urology is starting to blur. You may see both of us giving the same therapies, or working together to give therapies to patients.
With bladder cancer, for example, we look inside the bladder for local recurrences while the oncologists watch for more widespread recurrence. We may give certain chemotherapies directly into the bladder, which complement the systemic therapies they're giving.
Working in the same EHR helps with that. We can see the oncologist's documentation without having to request records or have them faxed and uploaded. It's a direct way to communicate with our oncology partners, and it makes patient care easier. When everyone becomes a team like this and is on the same page, the patient wins.
What excites you about the future of independent urology, and what role do you see for your EHR in that future?
I think we're all going to see AI integration just explode and go into creating individualized care pathways for patients. With genetics, individualized treatments, and technology that helps focus care for each patient, I think that's really exciting.
The treatment landscape for patients with cancer is a dizzying array of medicines and trials. It's hard to keep up with, but to see that bring people more quality and longevity of life is just so exciting.
It's a huge relief to have an EHR team that will be there if I have questions as those changes come. I don't know all the answers, but I have a lot of smart people who will tell me when a new change is coming. Then together, we will figure out what adjustments we can make to keep things easy and efficient for the practice, while bringing the latest treatments to patients. Having a malleable, adaptable EHR is so valuable to every practice going forward.
Thank you to Dr. Littlejohn for sharing your story, and for helping shape OncoEMR for urologists.
Through partnership with urologists like Dr. Littlejohn, we’ve enhanced our platform to meet the needs of urologists and other surgical subspecialties. Today, over 120 providers use OncoEMR for Urology to successfully treat thousands of patients daily. If you lead an independent urology practice and are exploring EHR options, we'd love to discuss what you’re looking for and how we may help. Reach out to us here.
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