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Family Physicians Share EHR Successes
Health IT Helps Practices Grow, Improve Patient Care
By Sheri Porter
As CEO of the Heart of Texas Community Health Center, Goertz said he could not imagine where the organization would be today were it not for that technological jump.
"Thirteen years later, I look back and it's amazing how things have evolved," said Goertz. "We certainly couldn't have grown and expanded to meet the needs of the vulnerable population we serve without our EHR."
In fact, Heart of Texas has tripled the number of patients it serves, expanded from a single location to 10 sites and improved multiple quality indicators for patients since it implemented its EHR in 1997.
Goertz said he could show beyond any doubt that the facilities under his purview -- all linked via health IT -- have improved the health care they deliver to patients.
He pointed to improvements in three clinical areas that, in time, made believers of even the most technology-reluctant physicians and support staff. For example, just 36 months after the system began tracking every patient with diabetes within the organization via the EHR, hemoglobin A1c readings for 1,400 patients went down by two points, from nine to seven.
"We essentially had a group (of patients) that was out of control and brought them virtually to control just on the basis of the EHR and the team approach to that disease," said Goertz.
Technology also gets the credit for a dramatic increase in immunization rates for children between the ages of 12 months and 6 years. Immunization percentages for that age group soared from just 40 percent to nearly 80 percent, an accomplishment that would have been extremely labor-intensive and nearly impossible to achieve using paper records, said Goertz.
The EHR also proved invaluable when the FDA recalled a widely used diabetic medication a couple of years ago. "We used the EHR system to notify every patient on that medication," said Goertz.
The health center's efforts paid off recently when it won the 2009 Healthcare Information and Management Systems Society's Davies Award of Excellence in recognition of it use of health IT.
Proof on the Plains
Brull said the EHR enables her to complete much of her work at the time of the patient visit, whether the task is ordering labs, X-rays or prescriptions or setting up a consult with another physician. "It all happens seamlessly, without any extra work -- something that wasn't possible in the paper world," said Brull.
FPs Offer Tips for Success With Implementing EHRs
- rethink how to deliver health care using health information technology;
- anticipate a production cut for at least the first month;
- provide adequate staff training and ongoing support, especially to the less-than-enthusiastic members of your organization;
- focus initially on functions that will immediately improve the patient care process, such as e-prescribing and electronic access to lab results;
- introduce quality measures to improve outcomes gradually;
- evaluate, adjust and adapt the technology and your practice as necessary; and
- involve patients with features, such as patient portals.
Electronic-prescribing software alerts Brull to medication interactions or unfilled patient prescriptions, a function that she said protects her and the patients under her care.
In addition, Brull finds feedback from quality improvement work extremely motivating. Currently, she is tracking population and patient-specific data on rates of mammography, colon cancer screening, and influenza and pneumonia vaccinations.
"If we touch a patient chart, we are reminded if the patient is due for anything," said Brull. "Our numbers have been improving for three quarters now, and we are very excited."
Solo Practice Success
Ho said her electronic systems allow her to offer same-day visits -- virtual or in-office -- that run on schedule. She promises patients the continuity of care that comes with a one-physician practice and health care based on current and evidence-based information.
Physicians should strive to "harness technology" as a means of reaching their own personal practice goals, said Ho, whatever those goals might be. Some family physicians may be looking for ways to work faster, while others want to carve out more time for each patient or spend less time tethered to the office.
Ho strives to "leverage the doctor-patient relationship by using technology to replace staff." She said her "stable of health IT tools" allows her to spend the right amount of time with each patient.
"Of course I could run on the hamster wheel as fast as anyone else," said Ho. But she's grateful that her technology choices mean she can run the kind of practice that she enjoys.
East Coast Early Adopter
According to Falkoff, a technology-savvy practice also attracts patients who not only are comfortable with health IT, but who expect their physicians to be wired.
That's why since 2007, the practice charges patients $25 a year -- or just 7 cents a day -- for access to personal patient portals. There's been very little pushback on the policy, said Falkoff, who boasts an 80 percent patient participation rate.
"Technically, it's a requirement of the practice, and we make it very clear to patients that the portal gives them access to their records and improves the quality of health care that we are able to deliver," said Falkoff.
"Once patients use the portal, they say it is the greatest thing," said Falkoff, adding that he was once able to manage a Hong-Kong-bound patient's Coumadin intake from Connecticut.
Shifting a medical practice to an EHR "requires a desire to do so and willingness to slow down, absorb the cost and lower the patient volume for greater returns later," said Falkoff.
His recipe for keeping his practice economically healthy is to "work smarter, not harder," with health IT. He sees an average of 15 patients a day -- never more than 20 -- and credits his EHR for helping the practice reap the financial rewards that come with better documentation and increased office efficiencies.
Were it not for health IT, this FP said he probably would have quit medicine a decade ago.
Falkoff insisted that seeing is believing. He extended this open invitation to his family physician colleagues: "Come visit me. Come and see what can be done with the right technology."
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Family Practice Management: "The 2009 EHR User Satisfaction Survey: Responses from 2,012 Family Physicians"
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