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Solo Doctor Champions Health IT for Patients, Peers

Chasing Paper

Dr. O'NeilAt Dr. John H. O’Neill’s former practice, it was not unusual for the doctors and staff to go on a paper chase to locate a patient’s charts.

For a doctor’s office, it was “well run,” he said, but “with paper charts, you never knew where anything was. That was so frustrating. We’d have group efforts to find charts. It would be on someone’s desk somewhere. When you had the chart, the information wasn’t there. The lab results were not there.” Neither doctors nor patients could be sure they had an accurate accounting of prescribed medications or lab tests.

Going Electronic

When he went into solo practice, Bayview Internal Medicine Inc. of Middletown, Del., O’Neill went electronic. Now after three years, records for all existing and new patients are kept as electronic health records (EHRs).

And he’s encouraging other physicians to adopt EHRs, telling them of his experience and how U.S. Department of Health and Human Services’ (HHS) Recovery Act programs can help them convert from paper to electronic records.

Dr. O’Neill is a “physician champion,” a participant in the Meaningful Use Vanguard (MUV), a program of HHS’s Office of the National Coordinator of Health IT in which Regional Extension Centers (RECs) identify health care providers in their area who are leaders in the early adoption and meaningful use of EHR technology. The MUVers work with their area REC to help other health care providers adopt and meaningfully use EHR technology – and thereby become eligible for incentive payments authorized by the Recovery Act.

Resources for Going Electronic

Widespread adoption of EHR technology by physicians and hospitals is a signature goal of the HITECH Act, part of the Recovery Act, to improve the quality of health care and make the health care system more efficient. The Centers for Medicare and Medicaid Services’ (CMS) Medicare and Medicaid EHR incentive programs will provide incentive payments to eligible professionals, hospitals and critical access hospitals as they implement and meaningfully use certified EHR technology.

The REC for Delaware is Quality Insights of Delaware (QIDE), a Quality Improvement Organization that has worked with CMS for 12 years on issues relating to Medicare patients. The REC has identified 221 MUVers so far and plans to recruit a total of 300 physician champions.

The REC acknowledges the MUVvers’ work, features them in its e-newsletters and videos on its website and involves them in conferences with other physicians and providers.

Going Physician to Physician

“We know the story best told is physician to physician,” Beth Schindele, the Delaware REC director, said.

O’Neill agrees: “There have to be physician champions. Physicians are an interesting species. They look around at their colleagues [and see what they’re doing]. They have to have a comfort level before they move. They drag their feet.”

The REC also uses webcasts to show doctors how to use health IT and develops communication materials in English and Spanish for them to use in educating their patients on the health care benefits of EHRs.

“At the end of the day, it’s about improving patient care. [EHR technology] reduces errors, empowers patients, improves communications among doctors,” Schindele said, and helps keep patients’ medications straight.

The REC would normally charge $100 an hour for its consulting services, but because of the Recovery Act grant that it received, that fee is only $10 an hour for primary care physicians in practices of less than 10 doctors.

How Health IT works for Dr. O’Neill

Dr. O’Neill says he’s not “a real techie” though he likes computers.  He initially used a portable wireless laptop for patient charting, but found it wasn’t fast enough. Now he has a hard-wired computer in each examining room. When he sees a patient, all of the lab tests, medication lists and medical history, as well as O’Neill’s clinical notes are right there in the patient’s electronic file. Most lab tests, including some x-rays and pathological reports, are automatically filed to the patient’s EHR and O’Neill’s inbox. (“I think that’s the coolest thing ever,” O’Neill said.)

The electronic filing of lab and other diagnostic test results to a patient’s EHR is a tremendous improvement to office operations for the physician and his or her staff, saving time and money, O’Neill said. But there are more than just patient-management benefits.

“It speeds up evaluation and treatment. If there’s a suspected tumor and an MRI is needed at 2 p.m., I usually have the results a couple of hours later. I can see the images online via high-speed Internet access. In the past, it was a couple of days,” O’Neill said. “We’ve had people evaluated and diagnosed in a couple of hours rather than days.”

O’Neill says his patients have not expressed any concerns about privacy issues dealing with their EHRs. His office follows Health Insurance Portability and Accountability Act (HIPAA) patient information security protections, and “as we move forward with the meaningful use efforts this year, ongoing evaluation and fine tuning of our information security processes is part of that package of requirements,” O’Neill said.

Overcoming Challenges

There are challenges to converting to and meaningfully using certified EHRs, O’Neill adds.

Entering data for existing patients is a time-consuming process that can’t be simply delegated to someone else.  At O’Neill’s office, the medical assistant inputs some of the prescription drug and allergy lists, but he does his clinical notes. “No one thinks like you,” he said.

The upfront costs of implementing certified EHR technology are not insignificant. But, the REC, which does not make recommendations on EHR vendors, can be very helpful at reviewing the contract and suggesting the weeding out of potentially unnecessary ‘bells and whistles’ substantially to reduce upfront costs of EHR implementation, O’Neill said.

“They’re accessible,” he said of the REC. “They have a distinct interest in my success. We could not have done it without them.”

O’Neill said he is getting a software upgrade soon that will help him qualify for the Medicare incentive payments by the second half of 2011, $18,000 for the first payment. He expects the incentive payments will help him recoup his $40,000 implementation costs within five years. His annual software and hardware costs for his combined EHR and practice management system are about $5,000 a year.  O’Neill says he’s recovering more in reimbursements because the EHR system allows for better documentation to support coding patient bills.

But vendor contracts, data entry processes and other challenges that he faced in adopting health information technology aside, O’Neill says he now “couldn’t imagine practicing any other way. If I had to go back to the old way, I’d probably quit.”

Using an EHR is helping him provide better, higher quality care to his patients. “And that’s what’s important,” he said, adding, “The most important thing to the patient is good care. What they really want is the care.”