Optimizing your EHR for the medical home
by Lisa Schneck on 9/24/2012 3:47:51 PM MST
The patient-centered medical home (PCMH) is all about efficient processes, data-driven improvement and service to the patient. An electronic health record (EHR) is an essential component of a high-functioning PCMH, maximizing the effectiveness of patient-centered strategies. Ideally, in a PCMH:
Providers get what they need when they need it, in the way they want it;
Patients and providers work as partners in managing patients’ health; and
Care is coordinated with the “medical neighborhood,” information flowing securely back and forth.
Your practice’s EHR can support patient care and office processes before, during and after each patient visit. Using an EHR facilitates your practice’s transformation into a PCMH; these applications closely align with the government’s requirements for EHR “meaningful use.” By optimizing the technology, you position your practice to qualify for meaningful use and the monetary rewards that come with it. Try to retool your work flows so they support both the PCMH and meaningful use.
“EHR optimization is a continuum,” says Kellyn Pearson, a healthcare informatics and technology expert with HealthTeamWorks. “Practices begin with implementation, focusing on getting data into the system. Once they feel comfortable with data collection, they can begin using those data for clinical decision support at patients’ visits. For example, the EHR alerts the care team about preventive or chronic disease-management services that a patient may need. Practices that fully optimize their EHR reach the point of generating reports for population management and performance evaluation.”
Use EHR capabilities before, during, after patient visits
Prior to the patients’ visits, your practice can use the EHR to send automatic appointment reminders to reduce no-shows. It can produce appointment lists so care teams can review scheduled visits for the day or week ahead and prepare for their patients.
During the visit, query the EHR for health maintenance alerts, such as overdue immunizations. Enter a patient’s clinical measures as you assess them in the exam room. Generate patient education handouts, as appropriate, and a visit summary in all cases.
After the visit, the patient’s most recent information becomes part of the EHR’s registry, helping you manage all those with similar diagnoses and your entire patient panel, as well. Use the EHR to send reminders for follow-up care; log the results of tests and referrals.
Optimize staff to optimize the EHR
To optimize your EHR, keep the human factors in mind:
Some member of the practice will take to it more quickly than others.
Everyone must use it for the technology to be effective. Don’t automate inefficiencies.
Establish written protocols and procedures.
Give staff plenty of notification before making process changes.
Test process changes for effectiveness. Let employees know how the EHR benefits them, as well as patients.
Your EHR vendor can provide extensive support and resources to help your practice get the most out of its investment. HealthTeamWorks can help, too: Our quality improvement coaches and health informatics experts have assisted hundreds of clinics in applying their technology to support PCMH and meaningful use.
EHRs and 'meaningful use': Brighton clinic's successful implementation
by Lisa Schneck on 7/11/2012 9:27:34 AM MST
By Hali Young, HealthTeamWorks intern
Platte River Medical Clinic (PRMC), a six-provider primary care practice in Brighton, Colo., has implemented an electronic health record (EHR) and attested to its “meaningful use” to meet the standards set by the American Recovery and Reinvestment Act. The federal EHR incentive program is spurring providers to embrace EHRs and use them in a meaningful way to receive cash bonuses based on the numbers of Medicare or Medicaid patients they treat. EHRs can make enormous improvements to a practice in efficient documentation, handling and availability of patient records, data security, data sharing and data analysis.
From August to November 2011, with assistance from HealthTeamWorks’ health informatics staff and other consultants, PRMC made a smooth transition from its original EHR to one that better fit its needs.
“This was the fastest and smoothest transition I’ve seen,” said Deb Maltby, the HealthTeamWorks’ health informatics consultant who worked with PRMC.
PRMC found importance of EHR
Meaningful use, a set of rules for implementing EHR created by the Department of Health and Human Services, now has a second stage that has proven challenging for many practices striving to implement their first EHR. Stage one of meaningful use entails data capture and analysis of records, and stage two, although not mandatory until 2013, uses an EHR to advance clinical processes. Nonetheless, Kate Euser, PRMC practice manager, understands the necessity of using the technology to the fullest.
“We get to spend more time with the patient, which is our priority in this industry,” Euser explained. “We’re not spending extra time searching for charts or filing papers — the EHR does that for us.”
The transition to a new EHR was not as difficult for PRMC as adopting the technology initially, but it was more time consuming. According to Euser, the main hurdle was retraining the staff, which at the time consisted of six doctors and 15 staff members. PRMC chose a new package with features that measure all of the meaningful-use qualifiers so the clinic can address any requirements it’s not meeting.
“The ease of implementation depends on leadership, having a good game plan and the willingness to change,” Maltby said. “The practices that choose a more aggressive game plan can implement an EHR in about five months or less.”
Various EHR packages to fit needs
PRMC’s first EHR was a good start to electronically file and manage their patient records, but Euser says that the new package acts more as a practice manager, with functions that allow the clinic to bill patients, schedule appointments and drop files directly into patients’ charts by scan or fax.
The plethora of EHR packages on the market challenges practices to choose the best fit. PRMC employees did extensive research and compared several EHR packages before making their final decision. Euser explained that HealthTeamWorks reassured the clinic in its choice, which made the process easier. Her success with the technology has helped the clinic expand to 30 members and leaders plan to open an urgent care center by the end of this year.
Euser encouraged practices reluctant to implement their first EHR and move away from paper records. “You have to make the decision that you are going to do it. It ends up making your practice much more efficient.”
A meaningful first: Solo practitioner is first in state to attest, achieve 'meaningful use' of EHR
by Lisa Schneck on 10/12/2011 8:35:30 AM MST
April 18, 2011, was the first day healthcare providers could attest their “meaningful use” of electronic health records (EHR) to the Centers for Medicare & Medicaid Services (CMS), which created an incentive program to encourage use of the technology. On April 18, 2011, Michael Mignoli, MD, an internist practicing in Lone Tree, Colo., attested to CMS for EHR meaningful use and passed — the first provider in the state to demonstrate prescribed ability with the tool.
“Meaningful use was a logical extension of the way I currently use my EHR,” Mignoli says. “[The requirements] were things I already do — I document patients’ demographics, problem lists and medical histories, ask them about their smoking, prescribe electronically. Why have an EHR if you don’t do these things?”
Tech-savvy from the start, Mignoli was an early adopter of EHR, acquiring his first in 1995. He’s never used paper charts. “Once you start down the [technology] path, you don’t want to give it up,” he says. Mignoli joined the Colorado Multi-Payer Patient-Centered Medical Home (PCMH) Pilot, convened by HealthTeamWorks, in 2009 because it was a natural extension of his interest in technology, quality improvement and patient-centered care. He received free help in meeting meaningful-use criteria from HealthTeamWorks, a partner of the Colorado Regional Healthcare Information Organization that promotes adoption and use of healthcare technology.
“I couldn’t have attested without the help of HealthTeamWorks,” Mignoli acknowledges. A HealthTeamWorks HIT consultant worked with him to prepare for the government attestation process.
“Getting an EHR is the right thing to do to improve the health of my patients. It makes it easier to provide high-quality care,” he says. But the small physician office “shouldn’t do it [meaningful-use attestation] only for the money. You’ll be sorely disappointed. The decision to implement an EHR should involve more than a cost analysis,” Mignoli says. EHR software and hardware costs, IT support costs and “soft” costs such as staff training and time “exceed the government’s remuneration,” in his opinion.
“Dr. Mignoli is very knowledgeable about electronic health records and is a health information pioneer,” says Elizabeth Brooks, HealthTeamWorks director of Health Informatics and Technology. “The range of EHRs at different price points weren’t readily available for the small practice or solo provider when Dr. Mignoli selected his EHR. Lately there are many ONC*- certified EHR options at different price points that fit the needs of a wider range of practice sizes. We encourage all providers who haven’t adopted an EHR yet to contact their Regional Extension Center to see what options are available.”
A Regional Extension Center representative will be assigned to assist the practice in finding a solution that fits the practice’s EHR budget. Providers in Colorado can find information about the Colorado Regional Extension Center (COREC) at www.corhio.org/co-rec.aspx.
Mignoli’s patients benefit from his progressive, independent approach to care and his optimized use of health information technology. “I love my relationship with my patients. I love being my own boss. I know my patients and what I need to do for them,” he says. “My EHR is a critical tool to help me know what I need to do and do it in an efficient way.”
*Office of the National Coordinator for Healthcare Technology
Registry helps practice alert patients of drug dosage hazard
by Lisa Schneck on 9/19/2011 8:53:15 AM MST
Technology assists in many other ways, too
Christopher Madden, MD, believes in the power of technology to improve medicine for patients and physicians alike. He’s seen quite a transformation since his group, Long’s Peak Family Practice in Longmont, Colo., acquired an Amazing Charts electronic health record (EHR) system a year ago.
“It’s given us the ability to streamline interoffice practices. We (colleagues and staff) exchange information all day through the EHR. We get fires put out throughout the day, instead of at the end of lunch or the end of the day like we used to,” he says. “There’s an ongoing flow of digital information that allows us to deal with things as they come in.”
FDA issues alert for simvastatin 80 mg dosage
On June 8, Madden and his colleagues had to deal with something right away. The Food and Drug Administration issued a warning about simvastatin (brand name Zocor), a popular drug to lower cholesterol. Research revealed that patients taking 80 mg. of the drug daily have an increased risk of muscle toxicity compared with those taking lower doses or similar drugs. Long’s Peak Family Practice, like countless other medical facilities nationwide, had to reach patients taking 80 mg. of simvastatin as soon as possible to prevent harm.
They turned to the patient registry in their EHR and searched for simvastatin patients by dosage. About 40 names came up, Madden says. “We called them and told them to lower their dosage and to come in to the office if they thought they might be having symptoms of muscle injury.” The automated registry delivered the names in seconds; without it, the practice would have had to search its practice management system for patients with hyperlipidemia and cull patients taking simvastatin — a cumbersome process — or more likely wait until patients called for refills of the drug.
Madden credits the EHR with many other advantages, including:
Saving him $1,000 a month on transcription charges because the EHR allows him to create templates and to enter information in real-time for quick and easy charting;
Tracking referrals, lab tests, consultations and more until they’re completed or the patient declines to follow through;
Allowing patients to communicate with the practice electronically through the patient portal, a feature patients enjoy and that involves them in their care;
Allowing the practice to be more proactive in following up with patients, creating reports and practice plans; and
Generating written care plans for patients, an important take-away after each office visit.
“We were as good as we could get on paper [charts],” Madden says, “but we’re more powerful with the EHR on so many levels, in the number of things we can do and the time we can do it in. We do more work in less time and save money.”
Practice will "easily" achieve meaningful use of EHR
Madden says the practice should easily achieve meaningful use of its EHR as delineated by the Centers for Medicare & Medicaid Services. Providers who do so can qualify for incentive payments totaling as much as $44,000 through Medicare or $63,750 through Medicaid. “We have all the mechanisms in place to get there.”
Long’s Peak Family Practice is getting help in achieving meaningful use from Elizabeth Brooks, HealthTeamWorks’ director of Healthcare Informatics and Technology. “Long’s Peak Family practice was involved in our PCMH Foundations program before signing up with HealthTeamWorks for Regional Extension Center Services, so they knew how to use a registry. With Dr. Madden as the lead technical provider and the readiness of all the practice’s providers to adopt an EHR, the time spent with them on the path to meaningful use has been exciting and inspirational. Long’s Peak Family Practice really understands the use of EHR technology and how it can be leveraged for increased quality of care and practice efficiencies,” she says.
Patient registry helps keep quality improvement on track
by Lisa Schneck on 8/16/2011 9:23:05 AM MST
An automated patient registry is an important software tool for medical practices. A registry helps practices provide proactive care, particularly to patients with chronic conditions such as diabetes, asthma and cardiovascular disease. By capturing and storing patient information, a registry enables a practice to categorize individuals by age, gender, health condition, geographic area and other attributes. It can provide reports by individual patient or by groups of patients, allowing you to monitor how well your clinicians manage the health of specific patient populations — an important capability for practice aspiring to become a patient-centered medical home.
A registry, for example, makes it easy to report the level of hemoglobin A1C — a key measure of diabetic control — for all diabetic patients. If you establish a diabetes support group, the registry can generate a report that compares A1C levels before and during the program to measure its impact. A registry can identify all your patients 65 and older who need a flu shot. It can tell you how many patients have blood pressures 130/80 or higher. In addition to helping you manage your patient population, a registry can track specific clinical measures necessary for pay-for-performance programs, research studies and arbiters of clinical competency.
Know your objectives before buying a registry
Many registries can alert the practice when patients are due for tests, immunizations, screenings or check-ups. Some can even send e-mails or text messages to patients reminding them of needed services.
“A practice can get a registry in a number of ways,” says Kellyn Pearson, a HealthTeamWorks health informatics consultant. “They can buy or create a stand-alone product or obtain the functionality through their electronic health record (EHR).”
Pearson works on-site in practices to help them choose and apply technology to achieve government-defined “meaningful use” of EHRs. HealthTeamWorks, a nonprofit organization, is a state Regional Extension Center (REC) partner that provides technology advisory services free to Colorado primary-care practices that meet eligibility guidelines.
“The learning curve for a registry involves knowing your system’s capabilities, and then learning to use it to your best advantage,” Pearson says. “It often takes a number of years for a practice to get comfortable with a system and learn to use it effectively.”
If your practice does not yet have registry software, it’s important that you know what you want to accomplish before deciding which system to purchase, Pearson notes. With more than 600 EHR products certified for “meaningful use,” making a choice can be daunting.
Good data in means good reports coming out
“Determining the best way to get data into a registry is another challenge,” Pearson says. The quality of information going in determines the quality of the reports coming out. Manual data entry can be slow and error-prone. The most efficient way is direct integration with an EHR, but this may not be an option for practices that do not yet have an EHR or for those whose current EHR is incompatible.
Each practice will need to chart its own path, but registry acquisition is worth it. Experience shows that a registry is a key ingredient for high-quality, patient-centered care. A registry allows you to identify and manage patient populations, plan and manage care, track and coordinate care and measure your own performance. Take every opportunity to reach out to your local REC and your colleagues with registries and learn from their experiences.
Darves B. Patient registries: A key step to quality improvement. ACP Observer. Sept. 2005. www.acpinternist.org/archives/2005/09/patient.htm , accessed Aug. 9, 2011.
You've got a friend:
by Lisa Schneck on 4/18/2011 8:17:06 AM MST
HealthTeamWorks helps providers adopt,
adapt to EHR in a meaningful way
Electronic health records (EHRs) represent both opportunity and anxiety for many medical practices: Opportunity because of the cash incentives that the U.S. government is offering to practices that demonstrate “meaningful use” of their EHRs, anxiety because of the enormous changes a group must make to accommodate the technology if it’s not already using it.
HealthTeamWorks assists practices in adopting, adapting to and maximizing EHRs. We are one of seven state healthcare organizations that have partnered with the Colorado Regional Extension Center (CO-REC) – part of the Colorado Regional Health Organization (CORHIO) – to assist primary care providers with that challenge. Services are free to qualified providers: Funding comes from the federal stimulus bill known as the American Recovery and Investment Act (ARRA).
Our seven health informatics consultants provide on-site guidance to practices in:
• Selecting an EHR system;
• Implementing a system;
• Optimizing practice work flow to ensure improved quality of care;
• Achieving meaningful use of an EHR to qualify for government incentive payments; and
• Ensuring the integrity and security of patients’ protected health information in accordance with HIPAA* privacy and security provisions.
Jasper Milliken, one of HealthTeamWorks’ health informatics consultants, cites the challenges presented when practices have EHRs, and when they don’t. “If they already have an EHR, they usually need help with work-flow issues. They’ve had trouble making a full transition from paper records and haven’t realized how to streamline old processes electronically – for example, using templates” with standardized questions to make clinic visits more efficient. Milliken and his colleagues teach physicians and support staff to maximize the labor-saving potential of their EHRs.
“If a practice doesn’t have an EHR, the challenge is usually overcoming change resistance,” he continues. “They may be very efficient with a paper-based work flow and don’t realize how an EHR can save time and labor. Some people are enthusiastic about going digital, but others fear change and push back.”
Nevertheless, the government is pushing all healthcare organizations to adopt technology. The federal EHR incentive program is intended to spur providers to embrace EHRs and use them in a meaningful way as defined by legislation within ARRA. Medicare providers who demonstrate meaningful EHR use can earn up to $48,000 apiece; Medicaid providers can earn up to $63,750.
Providers who don’t adopt EHRs and use them meaningfully by 2015 will be penalized by a 1 percent reduction in their Medicare payments. The penalty increases each year by another 1 percent to a maximum of 5 percent.
By helping practices establish and fully use EHRs today, Milliken says, “We’re also setting them up to be viable practices for the future. Ideally, we want to see integrated sets of providers working in accountable care organizations. But doctors mainly focus on patients in the here and now; they’re not always forward-thinking because of their daily demands. We take the burden of technology off of them and help them make the change to an electronic culture.”
*Health Insurance Portability and Accountability Act