EMR and Federal Funding - What you will want to know - November 9, 2009
In little more than five years, electronic medical records (EMRs) will be required by the federal government, and if the experience of local health care providers that already use such systems is any indication, the transition is likely to be bumpy, says Brian McCarthy CEO and well-known guest-speaker from Sencilo HealthIT Solutions in Orlando Florida.
Electronic medical records are large, complex systems that must be easy to use yet secure, and like many IT systems, implementing EMR can be complicated.
Putting an EMR system in place isn’t an end unto itself. In fact, it’s only the beginning for doctors and their patients. Like other software, the pace of updates and the number of features available are great and frequently changing. They’ll challenge health care organizations to keep pace, says McCarthy.
“Once meaningful use is defined, you’re going to see a lot of changes” to existing EMR systems and what they offer, explained Chris Diguette, director of application services at Fallon Clinic in Worcester. Fallon Clinic is a large, multi-specialty physicians group practice that has more than 20 locations throughout Central Massachusetts. Diguette implemented Fallon Clinic’s “MyChart” EMR system, which is a product of Epic Systems Corp. of Madison, Wis.
Beginning in 2011, health care providers deemed by the federal government to be getting “meaningful use” out of EMR systems will be eligible for incentive payments from the $51 billion allocated to the health care industry by the American Recovery and Reinvestment Act. The Obama administration wants all health care providers to be using EMR systems by 2015.
The U.S. Department of Health and Human Services is still working on the criteria for “meaningful use.”
Once that’s hashed out, health care organizations and patients will see EMR systems update at the same fast pace as other software products.
“You’re going to see reports being available so that you can deal with full registries of patients,” Diguette said.
Eventually, he said, doctors and patients will have entire medical histories at their fingertips.
“You can get the patient in and not have to have them come back every two weeks for different things,” he said. “You’re linking the lab tests, the diagnostic tests, the x-rays and immunizations, and MyChart is going to cater us toward that.”
Like any organization that uses software heavily, how quickly or slowly health care providers update the systems they use and whether they make full use of the systems they implement remains to be seen.
Risky Business
Still, getting past implementation is an achievement itself.
Dr. Peter Blanchard, a dentist and president of the Oral Health Center in Westborough, said EMR systems are “essential for improving health care.”
And when his practice, which sees some 14,000 patients, implemented an EDR (the D is for Dental) system, “we just took the dive. We implemented it in about a month.”
Luckily, the Oral Health Center had been using a fully electronic front office system for years beforehand. When it decided to go with a full electronic system, it found Dentrix Enterprise, which was compatible with the practice’s existing front office system.
“Fortunately, we had the front office system and were able to move that database,” Blanchard said. “The challenge was to implement the electronic charts, and we were able to scan in all patient charts. It was labor intensive and it continues to be labor intensive. And the initial build-out; the up-front cost, I can’t estimate, but it was significant. We have 14,000 patients with records that are continuously updating.”
Still, all the labor is worth it, Blanchard said. The Oral Health Center is about 75 percent paperless, he said. It uses electronic billing, but still prints prescriptions. And the way the system allows patients to understand their personal oral health and how to approach it is a boon.
At Oral Health Center, and at Fallon Clinic, doctors use computer monitors in each exam room to allow patients to better understand what’s going on.
“We have an added capacity to collect data on patients and there’s much more information available,” said Blanchard. “We can better analyze patient risk, and having all that in a database leads to better clinical decisions.”
Engine Swap
The doctors at Fallon Clinic would agree, but they didn’t jump into their EMR system with both feet.
Dr. Larry Garber, chief of informatics at Fallon Clinic, explained that the clinic has been paperless for more than two years, and took six months recently to roll out the MyChart system for patients.
MyChart allows patients to see what doctors see during office visits, and it allows the patients to access their health information and doctors from home.
“It actually empowers patients to take better care of themselves. We talked for years about empowering the patient, but we never gave patients the tools to truly empower them,” Garber said.
Fallon Clinic has spent $24 million in the first three years of going paperless and providing EMRs to patients.
“We’ll eventually recoup that, but in the meantime, we provide much better care,” Garber said.
He said wait times at the clinic and time spent in the exam room hasn’t decreased, “but now people can get care without coming here.”
And now, the clinic’s location on Plantation Street has more room, because all of those old paper files have been moved to a warehouse in Auburn. Also, the clinic doesn’t have to bother with having trucks transport paper medical records all over Central Massachusetts.
Today, 1,400 Fallon Clinic doctors and staff use the system and “several thousand” patients have signed up for MyChart.
“I used to show them their cholesterol numbers and their eyes would glaze over,” Garber said. “Now, they can look at it.” In fact, Garber can almost instantly pull up as much as 18 years worth of cholesterol data for any given patient on a single screen in graph form.
“It’s obvious and very visual. Patients at home can see test results the same way I see test results and they don’t feel like they’re secret anymore,” he said.
But it all took years of planning and preparation. Fallon Clinic had stored years’ worth of patient data in a database in anticipation of going paperless.
“Day one, it looked like we had been using EMR for 15 years,” Garber said.
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