Each night, Dr. James Johns takes his PC tablet home and practices a tutorial on it, just so he can slowly familiarize himself with a new electronic health records system that is to go live in late summer.
Along with learning a bit each evening, he’s looking beyond the technology – and the tablet he carries with him like a “paper” chart around the office – to a time when electronic health records (EHRs) will help him manage his practice, watch for trends, monitor chronic disease and make his patients healthier.
MEDICAL HOME MODEL
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With the practice in a large old house converted into a hospital, it’s telling that Dr. Johns envisions Little Flower as a medical home model, where it serves as the hub of a patient’s care.
“Taking good care of patients these days can be labor intensive. There’s a large amount of data that needs to be managed,” he says. Whether it’s monitoring parameters around chronic disease for specific patients or just promoting wellness for all, there are appropriate screenings, immunizations, data tracking and education that must take place in a quality practice.
“I feel that in becoming a medical home, having a good electronic medical system can assimilate and organize all that data. What I’m hopeful for is that by having a good system that keeps track of this large amount of information, it will allow me the freedom to be a doctor again,” Dr. Johns says. “I want to spend more quality time with my patients. If the medical home is done right, it brings what we’ve tried to do for the last 25 years into current technologies.”
Answers to questions will immediately be available electronically. “When did she have her last mammogram? When was his blood sugar tested?” Without wading through folders and or trying to locate charts, data will be at Dr. Johns’ fingertips.
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“An EHR is a good system. It will allow more doctors to practice quality medicine. We’ll pay for it in the first year, but as time goes on, ultimately, it will pay for itself by the good care we give,” he says.
Dr. Johns says he hopes his practice will be a model for other physicians, so they also can convert to a quality system with ease. “I actually got a tablet that I’m using as a computer. I’m used to carrying it around with me. I know it’s going to take work on our part to make sure the system we get is designed for our practice.”
But he knows he’s fortunate that his wife and practice manager, Donna Johns, shares the same vision and has the knowledge and background to move the practice forward. “You get all the raw materials set up and you need the right person to get it going in the right direction. She has the right goals. She knows how to merge new technologies with quality care so the system will make it easier – not harder – and provide better patient care than we do now.”
DONNA AS EHR SUPERSTAR
Donna joined Dr. Johns’ practice in 2004, after already implementing an electronic nursing documentation system at Mercy Medical Center of Canton. She knows patient data leads to quality medicine.
“I love data, and I’ve been trying to do quality management manually for our practice,” she says. “All providers think they give the greatest care, ask the right questions and do the right things. Not until you can actually get data and the numbers, can you prove you’re providing the best care.”
For instance, using an excel spreadsheet, Donna actually tracked diabetes patients in the practice to determine when they had an a1c, an eye exam, a foot exam, even if they visited the physician for a cold or chest pain. “Once we get an EHR and have a screen in front of us all the time, this will be updated automatically. That’s my dream,” she says.
Donna says staff and Dr. Johns each have a tablet PC that they can hold in their laps because that’s what they do with paper charts, so it’s not much different. While she knows there will be front work in loading the data about each patient into the system, she’s excited that once the data is there, staff will never have to look it up again.
“Everything we do is looking toward quality, measuring best practices, and “meaningful use” helps to provide those best practices,” she says.
“Meaningful use” is a set of federal requirements that ensures physicians will use electronic health records to track data, produce reports, e-prescribe, and eventually, share records with one another. The practice also will be able to provide preventive care by looking at whether patients have had mammograms, lab results for cholesterol, colonoscopies, for example.
Connectivity to other healthcare professionals and entities will be key to the practice’s success. “The one thing anyone getting an EHR has to understand is that they have to do the interfaces with the lab and radiology departments. If they don’t have that connectivity with other places, then all they have is a paper chart in a computer,” she says.
A reduction in both healthcare costs for patients and the practice will occur once that connectivity is established. With e-prescribing, the practice will be able to see what medications other physicians are ordering, what x-rays already have been taken, the results of lab tests or procedures already conducted. Duplicate procedures cost both the patient and doctor money. “It’s not good for patients. It’s these kinds of costs that nickel and dime us, and those are the things that drive up healthcare costs,” she says.
ALL SIGNED UP
Donna and Dr. Johns’ journey to selecting the right EHR system has sent them in many directions. Each year, they attended the American Academy of Family Physicians’ annual conference where they would meet with vendors, but Donna didn’t see anything that was easy to use and would work for the practice. She read, did web research, talked to as many people as she could and even received quotes from vendors.
Jim Carroll, the director of the Northeast Central Ohio Regional Extension Center, had worked as the former Chief Information Officer with Donna at Mercy Medical. At a seminar sponsored by the Ohio Health Information Partnership in October 2010, they met up again. This time, with the federal program for free Regional Extension Center Services, the time was right to sign up.
“It was very obvious that Donna is one of those star performers. She had her work done well in advance. They had evaluated vendors but didn’t have a process to see the differences and evaluate their responses,” Carroll says.
He recalls that Dr. Johns and Donna walked up to him and said, “We’re ready to sign up, and we could really use you.”
Carroll is responsible for signing up 874 priority primary care physicians to reach Ohio’s 6,000 goal. He used Little Flower as his training ground for the Welch Allyn tool, which allows the physician and staff to have a documented starting point.
The Welch Allyn tool thinks through the process by answering poignant questions like: What is the value of an EHR system? Do you have concerns? What do you want your system to do? What’s most important to you? Who is going to be involved in governance? Who is going to do the work? Who is going to do the charting? Do you want to scan your paper charts or just some of them? What about hardware? How many laptops, PCs and printers do you have?
“These become teachable moments,” Carroll says. “You can’t just expect your practice manager to do all of the work, or only train one doctor out of five. What’s nice is that you end up with a document that clearly describes the needs of the practice, and then you can provide as much information as possible to the vendor.”
For Donna, the most important aspect of selecting a vendor was what effect it would have on Dr. Johns.
“The most important thing in choosing an EHR is how it’s going to impact the providers. It might have a slick beautiful practice management part or report part, but none of that is going to matter if practioners can’t take care of patients,” Donna says.
WELCH ALLYN PREPARES THEM
What does this mean for my practice? That’s the essential question the Welch Allyn Prep Select Tool addresses, says Bruce Kleaveland, who is responsible for “shadow training” staff in medical practices all over the country.
He walks physicians and medical staff through the preparation for and selection of EHR systems long before they’re ever installed. Kleaveland introduces the 10-step tool to them, helps them understand the assignments and then, after they’re completed, discusses some 40 assignments with them over the phone and via the web.
This tool helps organize what can be a very complicated process into something that’s pretty easy to process in a step-by-step systematic fashion,” Kleaveland says. “So not only the preparation process but the decision-making process becomes a lot easier and less time consuming.”
When Kleaveland first assessed Dr. Johns’ practice with a survey about the use of an electronic health record system, he identified which staff members needed additional technology training, who would participate in the process, and what kinds of questions and reservations they had about EHRs.
For instance, all had computers at home, all knew how to routinely use emails, most knew how to attach a file to an email, but half said they questioned their technological skill levels. And the questions they posed are common among practices: Will it cut down on the time needed for patients? Will it slow the workflow in the office? How complex is the learning curve? How long will it take?
“I identified that this staff was an enthusiastic group with isolated concerns about what the project would mean for them, which is ideal for the leadership. Dr. Johns and Donna would be able to assess where the concerns were within the practice and then proactively address them,” Kleaveland says. “I was impressed with Little Flower because 100 percent of the staff felt the transition would be good for the practice as a whole. They said they’d be willing to invest additional time to learn.”
Immediately, Kleaveland knew this practice would have a good experience.
Donna says, “Welch Allyn is nice because when you start looking for an EHR, you have to think about what you don’t know you don’t have. You really don’t know what to ask, and the Welch Allyn tool helps you ask those questions.”
Which vendor should you select? It depends on what you want your EHR system to do. As with many different companies, EHR vendors are divided into segments based on customer size, so there are companies that tend to sell to larger organizations and those that target smaller ones, Kleaveland says. “If you’re out to buy an air conditioner for your home, you’ll be talking to a different vendor than one that handles air conditioning for a 20-story building.”
The challenge for Little Flower was to find a good fit for a smaller, family practice.
One decision a practice has to make is whether staff wants software on a computer in the office or over the Internet, where they can log onto someone else’s server. Little Flower has opted to have the software hosted off site.
E-MDS TAKES THE LEAD
By January, the practice had secured a loan from Key Bank, one of four banks working with the Ohio Health Information Partnership to offer reasonable interest rates to physicians who want to purchase an EHR system. And they chose e-MDs, one of the vendors that had given them a quote a year earlier. “The contract that the Ohio Health Information Partnership rendered made it a better deal than the one before,” Carroll says.
Dr. Johns says the contract that the Ohio Health Information Partnership negotiated with e-MDs received a thumbs up from his attorney. “You did a great job of negotiating good terms for us with different electronic medical vendors. And Jim Carroll was a tremendous help in talking with the different vendors and narrowing it down to the ones we singled out. And of course, Donna kept everybody honest and knew the contracts better than anyone. Everyone wanted the same thing. It’s a win-win for everyone,” he says.
At this point, Carroll turned the training over to one of his consultants and to e-MDs, who would be responsible for the implementation of the EHR system and the redesign of the workflow so the practice could meet meaningful use and receive federal financial incentives.
“Little Flower will be good candidates for reaching meaningful use. They have a well-run practice; it’s well established,” Carroll says. “This is a family practice, and their patients come first. The doctor has a small office, 8’ by 8’, but the rest of the place is devoted to patients and staff. He’s the epitome of best practices. She is a superstar and was well ahead of the curve.”
One of the largest EHR vendors in the nation, e-MDs is a preferred vendor that the Ohio Health Information Partnership chose after a rigorous review of some 40 vendors. The five preferred vendors include e-MDs, Allscripts, NextGen, Sage and eClinicalWorks. While a practice or hospital can use any EHR vendor, a legal firm negotiated contracts with these five preferred vendors in the best interest of physicians and other healthcare professionals, so a streamlined negotiation process would be easier.
Patrick Hall, the Executive Vice President of Business Development, says the fit was just right for Little Flower and e-MDs.
“E-MDs was founded by a family physician who ran a successful practice and over the years have worked with several thousand locations which are in the 1 to 10 physician size. This has given us a very good understanding of their dynamics, concerns, and special needs,” Hall says. “With our founder and current CEO both being physicians who are actively involved in product development, we are acutely aware that it is vital for a system to be highly usable at the point of care. The rubber meets the road at the point of care where efficient data entry will drive workflow, patient quality, and business efficiency.”
With a focus on small practices, e-MDs can assist physicians who otherwise might not have the IT support and knowledge within the practice to make implementation go smoothly. “In most cases, they don’t have the kind of administrative support one sees in larger groups,” Hall says. “They rely quite heavily on us to help them through the project and to continue to be there for them in an ongoing support capacity.”
Hall says e-MDs takes pride in the successful relationships they’ve built over the years. Many of their different teams have known practices for a long time and know a lot about the people within those practices because of these long-term relationships. With Little Flower, the process went smoothly, with no challenges.
“It was very helpful to have information from the Prep Select tool to make it easier for us to understand what the practice was looking for,” Hall says. “Although this was the first practice worked through the Ohio Health Information Partnership, it was great having multiple teams to ensure that all the elements were handled appropriately and with the interests of all parties taken care of.”
e-MDs continues to work closely with Donna, Dr. Johns and other staff members to prepare and train them. Hall says a practice can reasonably expect to “go live” with the EHR system in place within a 60 to 120 day timeframe. It depends on factors such as training options selected by the practice, the corresponding resource ability and whether any special elements exist, such as a data conversion.
LITTLE FLOWER GOES LIVE
It’s early August, and Little Flower went live in July with the practice management segment of the system, the EHR is soon to follow. As she looks back now about obstacles overcome, Donna says the biggest one is “not knowing what you don’t know, so you don’t know to ask,” she says. “The practical adjustment is to realize that the staff has a lot of hard work to do ahead of time, to make it work. They can’t sit back and let it happen to them; they have to be very actively and proactively involved.”
With the new system in place, Donna will be help Dr. Johns reach “meaningful use.” Medicare and Medicaid incentive checks are now being issued to physicians who are ahead of the EHR curve. Medicare incentives can add up to $44,000 per physician. Little Flower spent $20,000 on hardware and $32,000 on software and one-time fees.
“We will attest to meaningful use for the Medicare incentive before the end of this year,” Donna says. “The $44,000 from the government will not cover all of the costs. A practice should not do it for the money, but because it will help them improve the care they give the patient.”
