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By John Tallent, CEO
Medical Associates Clinic and Health Plans
Dubuque, Iowa
Seneca, S.C.
Medical Associates started using an EHR system in July 2003, thinking it would take us three years from go-live to achieve full adoption. Instead, it took five years, despite being a 1,000-person organization with strong management and a sophisticated IT department to drive success. However, healthcare IT has been a differentiator for us and will continue to be so long after the stimulus package has come and gone.
Our organization comprises two medical campuses in Dubuque — an occupational health clinic and nine regional clinics serving a 60-mile radius, including Iowa, Wisconsin and Illinois; and a wholly owned health plan. Most of our 108 physicians are significant shareholders, so in 2001 when we began looking to invest in an ambulatory EHR system, we really had to communicate the value of that investment. The majority agreed it was the right way to practice.
If We Don't Qualify for Meaningful Use, Few Will
Today, our EHR system is integrated with practice management and laboratory information systems. Results from the hospital populate our patients' EHRs, sometimes moments after tests are completed. We also have a fully deployed picture archiving communications system (PACS) for both radiology and cardiology, and have integrated some standalone clinical databases for tracking immunizations, anti-coagulant therapy and congestive heart failure patients.
Full adoption at Medical Associates looks like this:
 100% e-prescribing, orders and results
100% digital imaging
95% of charts documented online, except for a few specialties
892,000 encounters documented entirely online
1.7 million e-prescriptions
85% clinical user satisfaction
$1.2 million in annual savings
If our group does not qualify for "meaningful use," we are certain very few will. To drive widespread EHR adoption, the standard must be significantly lower than what we have achieved.
Staying Ahead of the Curve
From inception, our strategic clinical IT goals have remained the same:
Share clinical information and offer decision support to drive
clinical quality
Position for continued future success when clinical IT is required
Next on our road map is to accelerate clinical quality management efforts to support evidence-based practice, disease management and population health management. This will also position us well for future data transparency requirements. Together, these initiatives will keep us well ahead of the curve, where we've worked so hard to be.
Reflect How Top Performers Practice
Practices with the vision – and funds – to exploit technology have been able to distinguish themselves in terms of efficiency and care quality. Over the years Medical Associates has leveraged this advantage to earn several top performance rankings:
Awarded the Physician Practice Connections®-Patient Centered
Medical Home™ distinction by the National Committee for Quality
Assurance (NCQA), becoming the first physician practice in the
Midwest to be recognized as a patient-centered medical home
Identified as a Better Performing Practice for nine years by the
Medical Group Management Association
Maintained an "excellent" rating for six consecutive years from NCQA
Relative to most group practices, we have been at this a long time. Now that requirements are upon us, we're glad to be so far ahead. We also hope those requirements will reflect how Medical Associates has incorporated IT into our practices.
John Tallent has served as CEO of Medical Associates Clinic and Health Plans since 1998. He currently serves on the Board of Directors for various community and business associations, including the Dubuque Chamber of Commerce, the Greater Dubuque Development Corporation, the Dubuque Mercy Health Foundation and the Dubuque United Way. He also is a member of the CEO Leadership Council for the American Medical Group Association and a Fellow of the American College of Healthcare Executives.
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Association of Medical Directors
of Information Systems (AMDIS)
"The idea of defining [meaningful use] is important," says AMDIS Board President Bill Bria, MD, in an interview with Healthcare Informatics, "but it's probably not as important to AMDIS as the conversation. The conversation is not only amongst our group – the physicians that have the responsibility for HIT leadership around the country – but also with the public and with many other experts."
AMDIS in conjunction with Compuware has launched the www.meaningfuluse.org Web site to provide a mechanism to advance a national dialogue and education around "meaningful use." The new site enables visitors to access resources, collaborate, influence and discuss the definition of "meaningful use" and to learn how to take advantage of the HITECH Stimulus funds.
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