Ready for Meaningful Use Attestation

When the clock struck midnight on April 18, 2011, Jennifer Brull, MD, was ready. She had already registered for the Medicare Electronic Health Record (EHR) Incentive Program. She had her certified EHR system firmly in place, and working with the Kansas Foundation for Medical Care , the Regional Extension Center for Kansas, she had confirmation that her practice met meaningful use criteria. Dr. Brull was ready to complete her online submission to the Attestation System and qualify for Medicare/Medicaid EHR incentives. Dr. Brull was the first provider to attest in Kansas, and is a “MUVer”—a member of the Meaningful Use Vanguard, a group of  local leaders and advisors in the nation’s transition toward an electronically enabled health care system. She is also the first provider featured in ONC’s new series of print ads highlighting key MUVers who have adopted certified EHR technology.

But as eager as she was to hit the send button on her attestation, the incentives are just icing on the cake for Brull and her patients. She’s already seen a return on her investment, and most importantly, her patients have benefited from an even higher quality of care as a result of the  EHR system. ONC talked to her about what the transition to EHRs has meant to her, her practice, and her patients.

ONC: Tell us a little about your practice.

BRULL: I am a family physician in a very small community. The population of the county is about 5,000. The town is less than 2,000. I practice by myself, but I have two other colleagues who also have solo practices and we collaborate, sharing staff and equipment. We draw from an area of about 8,000 people, and we have patients who drive 30 or 40 miles to see us. Our critical access hospital in town was built about three years ago, and our practice built onto it. It is hard to imagine such a beautiful, well-designed medical facility in such a tiny town.

ONC: What do you enjoy most about your practice?

BRULL: I really like taking care of all different types of people. And my patients range in age from newborns to 101. I have one five-generation family, and it is so fun to know the whole family pattern and how that interworks with each other and their health—and how exciting a new grandchild is. I am also attracted to health information technology. I was the physician champion for our office and was in charge of the effort to get us moved to an EHR. The third thing that I am most passionate about is quality improvement. We did a lot of work in the quality improvement area way before we had an EHR. I really like seeing the way that we take care of patients and improve over time.

ONC: How has your EHR affected the quality of care in your practice?

BRULL: Preventive health is really important to me. With the EHR, I know that I am providing better quality of care to more of my patients. The first time I ran my numbers, my rate for colon cancer screenings was 37 percent, which is horrible. I looked at that and my stomach dropped. So we started doing inquiry projects and we figured out why the rates weren’t better. Then, we started redesigning the way that we do things and we put a reminder in the EHR that automatically notifies me [if someone has not had the test], and we put that right in front of my face. I am not perfect now, but I’m at about 81 percent, which is a lot better than 37 percent.

ONC: What has that meant to your patients?

BRULL: I found colon cancer early in three patients —so early that the patients did not even have to have chemotherapy or radiation. For those people, it was a huge difference, the difference between early colon cancer and invasive colon cancer.

And the improvement is true across many disease states, not just colon cancer. The EHR allowed me to develop a workflow and a process that means we look at everything that is important every time a patient comes in. Even if a patient comes  in with just a nose bleed, I am still seeing if their tetanus is up to date. The EHR also helps me have the answers to questions: Have you had your flu vaccine this year? Did you get your pneumovac? Have you had colon cancer screening? And, for women, did you have your mammogram? Our pneumococcal vaccination rate is about 96 percent, and the four percent includes patients that do not want it. Our mammogram rate is 99 percent. The quality of care and knowing I am giving better care to my patients are two of the biggest benefits of EHRs.

ONC: How has your staff responded to the transition from paper to electronic health records?

BRULL: From the very beginning, we involved our staff, starting with the selection process. We sent a front office champion and a back office champion to the training ahead and then they were the people who really helped onsite. We also involved them in how to implement the system. We did it in stages and a lot of that staged implementation process was based on their ideas. I think that attitude is everything. We laughed a lot, we threw chocolate at each other at bad moments, but it was a very positive experience.

ONC: Did you work with the Regional Extension Center for Kansas?

BRULL: I have been working with Kansas Foundation for Medical Care on quality work for a number of years, so it is a very nice natural extension to work with them on this. The REC coordinator has been out to my practice four or five times since I signed up. The biggest piece they helped me with was the security and the gap analysis. There were a lot of policies that we had in place, but not written down, so she helped me build those policies from strategic templates. It literally would have been hundreds of hours for me to try to do that myself. As a sole practitioner, I don’t have those hours—unless they’re middle-of-the-night hours. They also helped me track my progress so I knew when I had the green light for attestation. I have my numbers, and I know my numbers all qualify.

ONC: Congratulations. To you, your staff, and your patients.

Note: Dr. Brull submitted her attestation on April 18, 2011. She received her CMS incentive check on May 25, 2011. Read more about Dr. Brull (who is also President of the Kansas Academy of Family Physicians) in the AAFP News Now article.  Also be sure to check out our YouTube channel to view an interview with Dr. Brull .