“I have had so many patients tell me ‘Thank you, EHRs help me with diabetes management.’”

KC Arnold is a nurse practitioner and owner of a diabetes management practice, The Diabetes Center, PLLC in Ocean Springs, MS. Opened shortly after Hurricane Katrina, her practice allowed diabetes patients in the area to maintain their care after the storm. Ms. Arnold is part of the 1 to 2 percent of nurse practitioners who own their own practices, which she credits to her use of electronic health records (EHRs). In honor of National Nurses Week, here is Ms. Arnold’s story.

I worked for a satellite office for a private endocrinology practice when Hurricane Katrina hit the Gulf Coast. A few weeks after the storm, the main clinic decided to close my satellite office. I was told that I had a choice to make—I could move to the main clinic, or I would be released from my contract.

I knew that my patients had no other options for diabetes management in the area, especially considering that the damage caused by Hurricane Katrina forced many physician practices to go out of business. I decided that day to open my own practice so that the diabetes patients in my area could continue to receive needed care.

Feeling a sense of urgency, I created a business plan within 24 hours. The next day, I met with a local hospital to rent space. I also began planning and installing EHR software in my new office. Three weeks after I decided to go out on my own, my practice was open and I began seeing patients.

The Cost Benefits of Going Paperless

I was an early adopter of EHRs and have been using them since 2000. When I opened my own practice in 2005, I knew that I wanted to implement an EHR system. I even personally installed the EHR software on our computers the day before I opened my door to patients. My practice keeps a one-page summary of each patient, but we are otherwise paperless.

Because I have an EHR, I don't have the same costs as paper-based practices for things like prescription pads, transcription, or maintaining a physical patient chart. These elements combined have amounted to huge cost savings. I was able to get out of debt within one year of opening my practice.

I credit my success as a nurse practitioner owner to the use of EHRs. By using the system from the beginning, the practice was able to grow slowly and add staff gradually. I started the practice with one other employee and saw one patient on my first day. Today I have seven employees. We see an average of 100 patients per week and our annual patient encounters are 3,900 per provider.

EHRs Improve Patient Engagement and Diabetes Management

One of the primary benefits of using an EHR is increased efficiency. For example, I'm able to manage six to eight prescriptions per patient (which is typical for diabetes patients) in half of the time that it used to take in a paper-based system. As a practice that specializes in diabetes management, health information technology (health IT) plays a critical role in our work in several ways:

• EHR templates help manage care. The templates available for my EHR allow me to keep track of all that I do with my patients. I use about 50 different templates to coordinate patient care without having to retype information. Of course, each template is customized for every patient and visit, but they do give me an easy place to begin documentation. Templates also help me ensure that I've covered every item that needs to be addressed with the patient.
• Health IT for diabetes management advances rapidly. Patients can now upload their information from home to the software, send me a message, and I can look at their data online and upload it into their chart without having them come to the office.
• EHRs create interactive experience for patients. I always walk through the information I am logging into my patient's record with them after completing the physical exam. The patient and I look at his or her blood work as well as data from meters or pumps together, which makes the technology less intimidating and helps to keep patients engaged in their care. It also presents an opportunity to connect patients with resources that can help take them to the next level of diabetes management.
• Patient portals streamline patient-provider communication. We implemented a patient portal in the past year and a half, and I love it. The portal even helps to reduce errors; I often hear from patients who find mistakes in the record through the patient portal, which allows me to make the corrections immediately.
• Health summaries facilitate care coordination. Patients receive a printed health summary at the end of each visit where I note the changes we've made. I have had so many patients tell me “thank you.” The health summaries help my patients explain their care to their other providers and are vital during health emergencies. The summaries also help my patients stay on track in managing their health in the time between office visits.
• EHRs make 24-hour care possible. I can provide my patients with around-the-clock care through an application on my iPad. Patients can call me at any time, and I can refill a prescription through remote access or check the patient's medical record remotely. This lets me be away from the office and not miss a beat in providing care for my patients.

Providing Quality Diabetes Management through Health Information Exchange

One of the benefits of EHRs that we are most excited about is the ability to receive information from other providers. The Mississippi Community Health Information Exchange (MCHIE) helps us since we are able to download information from the exchange about our patients. We were happy to be one of the first outpatient clinics to have access to the exchange.

MCHIE is a great tool for my practice. Sometimes patients do not have all of the information they need with them, but we are often able to find the data, lab work, or hospital visit we need through MCHIE. Other times we are able to find our patients' lab results and other tests, which help us to be more efficient and save costs by not duplicating efforts. This data is especially helpful in my practice because patients with diabetes often see multiple providers.

I am looking forward to the next level of participation with MCHIE in which we can transmit our own information and notes so that other providers can see the data. My practice is designated to be one of the beta sites to begin uploading information to MCHIE from a private office.

This collaboration through EHRs and health information exchange can help us give better care to our patients. As providers, we need to make sure that our patients are taken care of, and EHRs make this a great opportunity to improve our ability to do so.