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By Susan T. Andrews, MD
Family Practice Partners, PC
Murfreesboro, Tenn.
The Challenge and Benefits of Technology
When Family Practice Partners, PC, first implemented Practice Partner® a decade ago as our electronic health record (EHR), it marked the start of a new journey for us. We'd spent two decades practicing medicine the old fashioned way — with paper charts and handwritten prescriptions.
Our processes changed even more when in 2003 we joined the Practice Partner Research Network (PPRNet), a practice-based, research network that provides care quality reporting to participating providers. Through these changes, we found new ways to improve how we practice medicine by leveraging healthcare technology to its fullest.
Adopting healthcare IT has forced us to think deeply about how we practice medicine and the ways in which technology can help us deliver better, safer care to our patients. It has also prepared us to meet the requirements for meaningful use and stimulus funding.
Working with Limited Resources
Adopting technology might seem to be a daunting task for a small, four-physician practice in Tennessee with no full-time IT specialist. Yet, not only have we been able to implement an EHR, e-prescribing and computerized physician order entry (CPOE), our patient care has improved in ways that wouldn't have been possible in a paper-chart world. Our success inspired us to begin working with the National Committee for Quality Assurance (NCQA) to become a patient-centered medical home.
Evaluating Our Stage 1 Needs
The quest for meaningful use has pushed us to take a close look at our systems and evaluate what we need to do in order to meet the milestones for Stage 1. For example, we would need to use e-prescribing at least 40% of the time and provide patients with an electronic copy of their health information within three business days more than 50% of the time. Currently we are exceeding the e-prescribing objective, and we're ready to provide patients with a CCR or CCD copy of their record.
During this process, we've discovered several "keys" to making the best use of our resources as we pursue the government's definition of meaningful use. These include:
 Create a checklist of each milestone
Appoint a leader for each major project
Evaluate your current system's functions
Make full use of the EHR
A Process for Adoption
Just a few months ago, we rolled out order entry, and within a short time, usage reached 60% for the entire group. As our physicians become more comfortable using this function on a daily basis, they will be better prepared to handle the enhanced requirements that we expect to be parts of Stages 2 and 3.
We approached this rollout the same way we tackled other projects, by designating one person to develop the process, get the kinks out, and train other members of the practice.
After implementing the solution, we brought our team together for open discussions of what worked and – more importantly – what didn't. This enabled us to learn where the roadblocks were, if providers needed more training, or whether we needed fixes for technical issues or additional training for providers not engaged with the system.
Adopting technology requires physicians, nurses and staff to change the way they work, but a successful implementation also requires that the system be adapted to the way they work. We want to do it the easiest way — simple is best.
Finding Support
Evaluating where you are in relationship to the milestones for each stage of meaningful use criteria can be a challenge. This is especially true for a small group. We can't dedicate someone to keeping up with unfolding regulations. In fact, it's hard for the small-town physician to even find good sources of information about meaningful use. It's simply not something we deal with every day.
Still you're not alone in this process. I found the American Academy of Family Physicians (AAFP) was a great source and have gotten good advice from other EHR users on Practice Partner forums and in User Group meetings. Your state Regional Extension Center can also be a great resource to help small primary care practices meet meaningful use, but it can come with a price tag.
Using What You Have
We've found that many of the items on our meaningful use checklist are already part of our operations. For example,
We adopted e-prescribing a few years ago — a core requirement
Vital signs and smoking status are already going into the patient record
Our system's lab interface enables us to incorporate all clinical lab test results as structural
data — an optional requirement for Stage 1
We also developed a letter template that can generate a summary record on each transition
of care and referral — another core requirement
This review has reminded us that we are not using every tool and function in our Practice Partner® EHR. We have a powerful incentive to look more closely at how we can leverage it to meet the criteria.
Quality reporting can be challenging as well. As a participating member of PPRNet, we can monitor and improve care for our patients through access to patient-level reports that measure more than 50 clinical parameters — saving considerable time and effort over generating documents through other reporting tools.
Many physicians may look at this process and ask: Is it really worth all the effort to qualify for what could amount to about $44,000 in federal incentives? Can a small practice really do it?
Based on our experience, the answer is an emphatic yes. Not only can you make great progress toward achieving meaningful use, but doing so will help you provide better, more efficient care for your patients. And when 2017 rolls around, you won't have to worry about a reduction in Medicare reimbursement because you don't qualify for meaningful use.
Dr. Susan T. Andrews co-founded Family Practice Partners, PC, in 2000 and was in private practice for 19 years prior. She is a national speaker and mentor for physicians seeking to implement electronic health records and improve quality. The practice has been featured in several national publications for its state-of-the-art use of computerized health records. Her practice was a recipient of PPRNet's Best Practice Award, which recognizes members in the top 10% of its research group.
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