Meaningful use is the most comprehensive change Keetah Clouse has seen in her 37 years in health care. "It rocked our world," says Clouse, project manager for meaningful use attestation, Premier Healthcare, LLC, Bloomington, Ind., an 80-provider practice with eight satellite offices. "The move toward meaningful use forced us to get better at thinking outside the box. It's had the same affect in a lot of physician practices."
To date, the multispecialty group has received $810,000 through the Medicare and Medicaid Electronic Health Records Incentive Programs, which provides payments to providers when they can demonstrate meaningful use of certified electronic health record (EHR) technology. Under Stage 1, physician practices and other eligible professionals have to comply with 20 patient-centered objectives and measures, such as documenting patients' smoking status and providing clinical summaries to patients after visits. Hospitals have a similar list of meaningful use requirements.
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Premier achieved Stage 1 meaningful use for 45 of its eligible providers in November 2011-and is now gearing up for Stage 2. So far, the journey is resulting in better patient care, says Clouse. "We're now able to track every interaction with the patient through our EHR. It enables our providers to use timely medical information to limit additional or wasted tests and procedures. There's no more paper; the chart room is gone. Our medical records staff, which we've been able to minimize from 22 to three, is more efficient."
Like Premier, White Rose Family Practice, York, Pa., has also achieved Stage 1 meaningful use and is turning its focus to Stage 2. While Stage 2 requirements have not yet been finalized, a proposed rule was released in February that describes the potential criteria providers will need to meet. Stage 2 expands on Stage 1 requirements and includes rigorous expectations for the exchange of health information-among providers and between providers and patients.
"The simple part is that most of what is required in Stage 2 was also required in Stage 1-just at lower levels in Stage 1," says Whitney Almquist, business manager. "The harder part will be to continue to focus on getting patients to actively and increasingly access the office electronically and to communicate electronically."
Premier-which prides itself in being one of the most technologically advanced medical groups in the Midwest-was ahead of many other physician practices when it began to prepare for Stage 1 meaningful use in 2009. It had an EHR in place, and physicians were already e-prescribing.
Even so, the practice had a lot of work to do. "The time spent preparing was probably the most important time spent during the whole meaningful use process," says Clouse. "We looked at what processes we had in place and the required measures needed to achieve meaningful use."
Clouse credits three strategies for Premier's Stage 1 achievement.
Implementing an analytics dashboard. To track how it was progressing on the 20 Stage 1 measures, Premier implemented a practice analytics dashboard. "Once we implemented the dashboards, we were able to track individual physician performance for each of the meaningful use measures and use that information to pinpoint needed workflow adjustments. We ran and distributed the dashboard reports every month to providers and their office staff. The dashboards were tremendously valuable in this respect."
The dashboards helped pinpoint areas for improvement, says Clouse. "For example, we thought we did a good job of tracking tobacco users and cessation efforts. We weren't. For smoking cessation and hypertension, in particular, it became apparent that we needed to do more."
Changing processes. Some of the changes Premier made to existing processes to qualify for Stage 1 were "painful," says Clouse. "The visit summaries presented a large process change, and we did encounter provider and staff resistance," she says. The practice also had to make changes to ensure that required demographic information, such as race and ethnicity, was documented.
Developing an online patient portal. Premier's secure online portal gives patients access, on request, to electronic copies of their health information (including diagnostic test results, medication lists, and discharge summaries), as well as clinical summaries of their office visits.
"Through the patient portal, we've been able to register-and actively engage-more than 4,000 patients since January 2011," says Clouse. "Feedback indicates these patients are pretty computer savvy and value the added service and direct connection to their care providers. The patient post-visit summary has become very important to them. Because of these factors, I think we are providing better care for patients."
As it prepares for Stage 2 meaningful use, White Rose Family Practice is also encouraging greater use of its patient portal, says Almquist.
Under the proposed Stage 2 rule, at least 10 percent of patients will need to view, download, or transmit their medical records through a secure online portal. Also, under Stage 2, clinical summaries must be provided to patients within 24 hours (versus in three business days under Stage 1) for more than 50 percent of office visits.
"That tells me that I need to impress on our providers and staff the importance of making our portal a primary way of communicating with patients," she says. "Right now, patients are communicating with our office, but other than responding to lab results, our providers and staff are not using the portal as a primary method of communication. This will need to change to meet Stage 2 requirements."
One way the physician practice might increase portal use is by automatically registering new patients for the secure website. This approach would simultaneously help White Rose meet another proposed Stage 2 objective. "In Stage 2, we are required to provide 50 percent of our patients with secure online access to their records, so by automatically registering new patients for the portal, this would be accomplished," says Almquist.
White Rose is also working with its dominant radiology facility on receiving its radiology results electronically. The proposed Stage 2 rule requires that 40 percent of imaging results be accessible through a certified EHR. In addition, the practice is taking steps to meet the Stage 2 requirement of computerized physician order entry for radiology.
Premier is using a portion of its EHR incentive money for completing much needed technology upgrades, according to Clouse. "Some of the money was used to bring our computer equipment up to date. We bought new computers-180 of them-for the clinical staff," she says. "Because of the investment, we are more efficient. Staff is much more focused on their work."
Achieving Stage 1 meaningful use can be done with a few people as long as there is a solid commitment and a plan for carrying it out, says Clouse. "There were only three of us managing the meaningful use process, and I'm very proud of that," she says. "We did not hire additional staff and worked only with the software portion of our IT team. There was no greater feeling of pride than when that first check came in after the initial test run of attestation."
Interviewed for this article:
Whitney Almquist is business manager, White Rose Family Practice, York, Pa. (email@example.com).
Keetah Clouse is project manager for meaningful use attestation, Premier Healthcare, LLC, Bloomington, Ind. (firstname.lastname@example.org).
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