A national conversation on the value of health information technology, or health IT, and electronic health records, or EHRs, is taking place as the federal government continues to push physicians to adopt the technology via the American Recovery and Reinvestment Act and the Patient Protection and Affordable Care Act.
Jerad Widman, M.D., takes his eyes off of his patient, who is out of view in this exam room photo, for just a few seconds so he can check information in the patient's electronic chart.
Talking about the benefits of health IT, however, is one thing. Seeing how family physicians actually use the technology in a busy family medicine practice is quite another, particularly as FPs are on the front lines of implementing EHRs.
That's why AAFP News Now wanted to spend time with family physicians who are actively engaged in using health IT. We wanted to see firsthand if EHR systems really could increase practice efficiencies and the quality of patient care family physicians deliver.
"The computer is a window to the world. You have everything at your fingertips," says David Voran, M.D., of Platte City, Mo. "The minute you sit down and turn the screen to face the patient, you have the patient." Period.
AAFP News Now recently paid a visit to Heartland Clinic of Platte City, a physician-led clinic that includes family medicine, pediatrics, internal medicine and specialty clinics. Voran and his family physician partner, Ann Riggs, D.O., comprise the family medicine component of the clinic.
Voran is much more than a family physician who's a fan of EHRs. He's known as the "champion" of innovative technology at the clinic, and he uses all available resources to develop health care partnerships with his patients.
"I want patients to be in charge of their health," says Voran. He's standing in the middle of his private office surrounded by no less than seven computer screens of varying sizes. He's constantly testing and tweaking and experimenting to find what best serves his staff and his patients.
Take, for example, the 23-inch screens he's installed in every exam room and at the nursing station. "Just by giving them a little more screen space, we've made their lives easier. It takes them less time to do their work, and at the end of the day, they're less stressed," Voran says of clinic staff members.
The office flow is fast and efficient. "Cycle time from the front desk to departure is about 40 minutes," says Voran, and the patient spends less than three minutes in the waiting room.
The nurse takes vital signs, checks the patient's medications and starts the visit note in the patient's electronic chart. Today, between 9 a.m. and noon, Voran sees 11 patients, and before lunch, all 11 visits are charted and complete save for two narratives on which Voran wants to spend a little more time.
But let's go back to the exam room, because that's where the real magic happens with Voran, his patients and the EHR.
First thing this morning, a young woman with abdominal pain needs an X-ray. The film is taken here in the clinic and immediately goes electronically to a radiologist in nearby St. Joseph, Mo. In the exam room, Voran and his somber patient sit side-by-side looking at her X-ray on that 23-inch computer screen. Voran points to an area of blockage, explains its implications and discusses what needs to happen next.
A subsequent patient with ear pain is amazed to be able to see on the computer screen exactly what Voran sees inside of her ear. He's using an otoscope with an external device that feeds the image straight into the computer.
David Voran, M.D., helps patient Melissa Smith understand her hip pain by showing her visuals of human anatomy.
Voran carries either a tablet PC or an iPad with him as he zips in and out of exam rooms. He likes to have patient education materials at his fingertips. One patient sees a demonstration video about how to irrigate his sinuses with a nasal wash and a "Neti Pot." Another bends close to the computer for a better look at images in Netter's Atlas of Human Anatomy. Voran uses his finger to trace the source of the woman's sciatic pain. He tells his patient, "I want you to research this with me."
Every patient has a "patient portal," and Voran communicates often and effectively through this secure messaging system. This morning, he wants to communicate to a patient about some abnormal lab results that have come in. He types out a message that ends with this friendly jab: "Yes, I know you like to bake, but that's the source of the problem."
The patient will get an e-mail message saying she has a secure message from Voran waiting in her patient portal. And she'll probably laugh when she reads it.
Voran says he eliminates eight to 10 office visits a week because he can deal with so many patient questions -- such as prescription refills -- electronically. He doesn't consider those lost appointments as lost revenue because their absence opens up slots for new patients or makes time available for more complicated patients who require a higher-level visit.
Do patients like their portals? Ask one of Voran's many patients who live in suburbs that are a fair drive from the clinic. "They come in for their annual visits, but we're able to take care of many of their other health care needs online," says Voran.
About 25 miles south of Kansas City, Mo., Jerad Widman, M.D., of Spring Hill, Kan., is nearly six years into his solo practice and has used an EHR since the day his practice opened.
"While no solution is perfect, compared to the paper charts I used in residency, the positives I gain with my EHR ensure that I'll never go back to paper," says Widman.
Spring Hill Family Medicine has an active patient panel of more than 1,860 patients and boasts about its efficient EHR system. Widman sees about 95 patients a week and models his practice with patient-centered medical home concepts in mind. "It's hard to imagine how I would do this work without an EHR," he says.
For example, when a patient with diabetes is overdue for a hemoglobin A1c, the EHR "rules manager" alert system goes to work. As soon as the patient's electronic chart is opened -- and often it's by the receptionist who has the patient on the phone making an appointment -- an alert pops up. "Even if the patient is calling in because they have a cold, the receptionist is able to say 'Oh, by the way, you are overdue for your diabetes follow-up, as well,'" says Widman.
An EHR query also allows Widman to see which of his patients with chronic conditions, such as asthma or hypertension, need follow-up care. "Of course, with our ultimate goal of partnership in care, we prefer that they would have scheduled on their own," says Widman. "But we're able to contact them and get them back in the loop to optimize their care and promote their long-term health."
Ditto for wellness care. "We're able to identify patients who haven't had a physical in two years," says Widman. "We can make proactive contact with them and bring them back in for that physical. Typically, we identify one or two issues they didn't even realize needed to be addressed," he adds.
Tracking quality measures is also an uncomplicated task, and the EHR greatly simplifies the reporting requirements Widman needs to follow to qualify for incentives through CMS' Physician Quality Reporting System.
Electronic prescribing? It's built in. A steady stream of patients this afternoon tell Widman where they want their prescriptions sent. Five seconds later, he's able to pull the pharmacy up on the screen, and 30 minutes after he hits "send," the patient's prescription is waiting for pickup.
Widman says his practice is ranked in the top tier of hospital and insurance company quality reporting markers "on all measures for all conditions with very rare exceptions -- no matter what the condition." He credits his staff, his patients and his EHR.
"Because of the efficiencies of the EHR, we're able to provide quality care --consistently," says Widman.
Jerad Widman, M.D., explains a treatment plan to Katie Masters, center, as her mother, Maggie, listens in.
It's obvious this FP is keen on the benefits of his EHR. But what about his patients?
Maggie Masters has brought her teenage daughter Katie in for an acute problem this afternoon. Masters is nothing but complimentary about Widman's use of technology. "It's more personal and it's quicker," she says. "The doctor doesn't have to leave the room to find a record, or look something up, or spend time flipping through the chart."
Widman says that the exam rooms were designed with patient rapport in mind. That's why a computer -- on a height-adjustable swinging arm that can accommodate Widman's six-foot frame -- is tucked into one corner of each room. When the doctor is facing the screen, he's also facing his patient. "This way, I'm able to maintain eye contact while typing," says Widman.
"I've never once had a patient complain about the use of the EHR. In fact, it's something that patients seem universally impressed by and thankful for."