Written by: John Lynn
Yesterday morning, River Falls Medical Clinic (RFMC) of River Falls, Wisconsin, attested for Meaningful Use at 7:30 a.m. CT. The clinic was one of the very first – in fact, #23 to attest to meaningful use under the Medicare program. The following is an email interview I did with Dr. Tashjian about RFMC’s experience in the meaningful use attestation process.
Christopher H. Tashjian, MD is the president of River Falls, Ellsworth & Spring Valley Medical Clinics in Wisconsin. The three clinics provide primary care services as well as specialty consults.
How long have you been using EMR? Which EMR do you use?
River Falls Medical Clinic, RFMC, implemented Cerner’s Ambulatory EHR in March of 2010 after several years of working with Cerner’s PWPM solution.
Did you have to upgrade your EMR to meet the certified EHR and meaningful use requirements?
From day one of EHR implementation, our staff has made it a priority to utilize our EHR solution to its full extent to benefit the care we deliver to our patients and to enhance our workflow. From the time Meaningful Use was announced, our staff was quick to realize that the proposed criteria would help us to better utilize our EHR and to enhance the care and delivery of that care our patients. We made it a goal to not simply attest for Meaningful Use for the monetary benefits that the stimulus dollars provided, but to more importantly enhance patient care. Therefore, we did not upgrade our EHR to solely meet the certified EHR/Meaningful Use requirements. We did add several pieces into our daily routines including Cerner’s departure summary and patient education –even though this piece isn’t required this year, we know that it will be in stage 2 and beyond. We also continued to improve our eprescribing procedure. We will also be upgrading to include Cerner’s IQHealth® solution to provide a patient portal that enables patients to review their own information and interact with us within a secure platform.
How much did it cost for you to do that?
There is a cost to move to an electronic record from paper – RFMC’s physicians feel it is vital to recruit today’s top medical students/residents. We felt if we did not have an EHR, we were at a serious disadvantage. More than 70% of the physicians in our area have gone electronic– we had to stay up-to-date. Patients in our area want to see a physician who has embraced technology and made the commitment to enhance patient care and safety; they want a physician who is moving forward with technology, not one who is still using paper when a better option is available. There is a cost associated with being a provider of choice and RFMC, like any other physician office, wants to attract new residents (physicians) and new patients. Providing better care is one way to do this. There is no way we could stay competitive in the marketing place if we did not choose to go electronic. The cost of not doing so was too high.
Why was it important to you/your office to be one of the first physicians in the nation to attest?
We wanted to make sure we were doing it right – we looked at the Meaningful Use requirements and said, “These things all appear to provide measurably better care.” Our physician’s felt that meeting Meaningful Use requirements would point our focus in the right direction. Most importantly, we wanted to follow the steps to enhance care. There is value in being one of the first physicians to attest and in being able to tell our community that RFMC is up and running at the first opportunity. This is of significant value to us. Additionally, our physicians literally put their own dollars into the HER; we made a personal investment in this. Many private groups owned by physicians have followed the same suit. This is not a situation where we just said, “Okay, we can rearrange some dollars.” If we don’t succeed – we don’t take our money home. It’s very personal to us as individuals and meaningful because we practice medicine to help our patients. Additionally, we wanted to be able to assist our fellow physicians in the process. By being one of the first physicians in the nation to attest, I can provide feedback and suggestions to assist others in the field.
How many hours of extra effort do you estimate it took for you and your staff to meet the meaningful use criteria?
We were committed to meeting Meaningful Use requirements already, so it’s difficult to say exactly how many hours we put into this initiative specifically. There were many hours spent making sure we met the requirements. We felt the requirements were so valuable and worthwhile that we began working on them day one because we felt they would enable us to deliver better care for our patients. Instituting an EHR required significant effort to change the way we document and the way we take care of our patients, but we saw this as part of the natural cost of doing business and we chose to do it in real time rather than seeing fewer patients. Our staff simply worked more hours – longer hours –so we did not interrupt the care to our patients. Within 6 weeks we were back up and running at full speed – this really is a fairly rapid adoption.
What were some of the changes you had to make to your practice style or documentation methods to meet meaningful use?
We aim to have all notes completed the same day. For us, this was a huge transition from the dictation world. Our team had to learn to document electronically and have things done by the time the patient left the room. This is vital for our patients incase they find themselves visiting the ER that night or seeing another physician that day. In these cases – the information on their visit with our physicians is complete and available. We also completely transitioned from writing prescriptions and went all eprescribe.
There were several changes in the way we practice. For example, now, every visit ends with the patient summary, which I never did before. Now, I sit down with the patient and whoever is with them to discuss, “Here is what we did, here are the tests we conducted today, the labs we completed and prescriptions written.” I provide a full, comprehensive overview of their visit. Incorporating the patient summary into the exam has enhanced my relationship w/my patients and they feel more confident walking out the door. Before, visits ended with a physician writing a prescription and saying goodbye.
We’ve also decided to put printers in every room to provide the after visit summary to our patients. We want everyone to receive their after visit summary and to get the appropriate patient education. We’ve gone to two-sided printing for all documents, so we aren’t printing anymore than what is absolutely essential for each situation. This is helpful for our elderly patients who are on multiple medications, which can get confusing. It’s easier to keep track of everything if it’s written down. We’ve also received feedback that this is valuable for their caregivers who may not have been in the exam room with them. On the other end of the spectrum, this is incredibly beneficial to parents of children, particularly newborns. Parents want to track progress and they want to be able to easily recall information. As we adopt Cerner’s IQHealth®, we anticipate moving the majority of this information into the patient portal for easy accessibility and storage in one central location. We also regularly utilize the immunization registry, which we did not engage with previously.
What steps did you take to ensure you were ready to attest?
To ensure we were ready to attest, we used the reporting capabilities within Cerner’s solution to extract the appropriate data. We used weekly reports to note where each physician was in regards to meeting the requirements for attestation. We also enlisted the support of WHITEC, The Wisconsin Health Information Technology Extension Center, to make sure we covered every base.
Were there any surprises in the meaningful use attestation process?
I was overall impressed that the process was put together so meticulously. There were multiple forms that needed to be filled out as we went through the process, and our staff truly did their due diligence prior to “pushing the button” to ensure we were ready. Thanks to the staff’s preparation, we were prepared when the numbers were requested. It was very easy for us.
Who helped you through the process (your vendor, a consultant, your REC, etc)?
Cerner played a large part in our success. Early on, we began working with Karen Berg, a Cerner Ambulatory director, who came to our clinic to meet with our quality physicians and walk us through the process of getting signed up for Meaningful Use. Berg worked through our questions to help physicians get ready to attest. She highlighted the need for us to prepare for Meaningful Use and beyond and laid out foundational steps for us to focus on patient care beyond Meaningful Use. We have been pleasantly surprised by the wealth of resources available through uCern, a collaborative website for Cerner clients, and we use them regularly. Additionally, our office manager receives regular emails from a group of people at Cerner who are dedicated to help their clients attest and prepare for certification. On our behalf, Cerner also works hand-in-hand with WHITEC, a health information technology extension group that our peer review organization put us in touch with. WHITEC has been very helpful for directing us through the Centers for Medicare and Medicaid Services website and doing research around questions that arise.
What benefits are your patients seeing from you showing meaningful use of an EHR?
Overall, our patients are receiving better quality of care as a result. They’re receiving patient education as well as after visit summaries and their information is tracked for accuracy. Their immunizations, which are one of the most complicated things for parents of minors to track, are recorded in the immunization registry and interfaced with the Wisconsin Immunization Registry. We’ve eliminated errors through eprescribing, there are simply no more errors due to handwriting legibility. They don’t have to worry about losing a prescription, because we send it directly to their pharmacy electronically. Eprescribing also conducts side effect checking and keeps record of the time and date a script is written and sent. Interoperability is a huge benefit for our patients – there is now no need to transfer things to other physicians in our 5 sites, which saves the physician and patient time.
What efforts are you taking to progress towards meeting meaningful use stage 2 and beyond?
RFMC is excited to move forward towards Stage 2 and beyond. We’re already working on next year’s goals; that is, giving diagnosis related patient education to my patients.” We have implemented Patient Education within our practice. We’re moving ahead to continue to deliver the best to our patients.
What do you say to your fellow doctors who are concerned about implementing an EHR in their practice?
I have never met a physician (who has moved to electronic records) say they would like to go back to paper. True, it requires a concerted effort to move to the EHR but the gains in patient care are worth it.
What do you know now about attesting for meaningful use that you wish you knew prior to attesting?
Be organized, choose the right vendor and all will go smoothly. If you actively work to do what is in the best interest of the patient, meaningful use will naturally follow.
What can you share with other physicians who are getting ready to attest in the next weeks and months?
There is very little way to prepare other than to prepare your attitude. Meaningful Use is the way the industry is going and we’re on board with a focus on our abilities to better our care – it’s a job standard to move in this direction. So, jump on board.