• A Bronx Family Practice Is Adding Meaning to EHR Use

    Sep 26, 2013

    Riverdale Family Practice’s EHR is freeing physicians’ time for patient care by allowing medical assistants to screen patients for routine testing before physicians even enter the exam room.

    Photo: A Bronx Family Practice Is Adding Meaning to EHR Use
    Riverdale Family Practice is leveraging its electronic health record (EHR) and related IT functions to improve the quality of care it delivers to patients. The 48,000-patient practice, located in the Bronx, N.Y., has successfully integrated all patient records into its current EHR. In addition, the system’s patient portal went live this year, and more than 8,000 patients have signed up to use the patient portal.

    To encourage interest in meeting meaningful use standards from the Centers for Medicare & Medicaid Services, the practice offered its physicians individual incentive payments for attesting. The practice attested to meaningful use in 2011 and also received Level III Patient Centered Medical Home recognition from the National Committee for Quality Assurance.

    Ensuring Continuity of Care

    Riverdale Family Practice uses an open-access model of healthcare delivery, which allows all walk-ins to be seen by a physician. Thus, EHR features such as the patient medication lists and medical histories are particularly important. These features ensure that all physicians in the practice have access to the patient’s history. Any services that are performed or ordered during a walk-in visit are documented for other physicians who may be treating the patient in the future.

    The family practice has also established EHR interfaces with three laboratory chains that have facilities in the area. Results from these labs are populated automatically into the EHR system for the physicians to review. In addition, any urinalysis and blood count testing that is performed in-house at the family practice is automatically integrated into a patient’s EHR.

    Building Clinical Teamwork

    The practice began to realize the need for clinical decision support before EHRs were available. For example, when the practice realized that its pneumonia vaccination rates were very low, staff began putting stickers on the charts of patients who had not yet received the pneumonia vaccine but were eligible for it. As a result, the practice’s pneumonia vaccination rates increased.

    With the EHR system, the practice has been able to expand and improve these efforts by running patient registry reports electronically on a broader range of quality measures to check which patients are missing flu shots, lab tests, and other types of preventative care.

    The EHR’s clinical decision support system also alerts medical assistants at Riverdale Family Practice about services that are needed for particular patients, including mammograms, colon cancer screenings, and influenza vaccinations. Some of the alerts were built into the purchased system, while others were customized by the family practice to reflect its particular patient populations. Once the EHR indicates a notification about a test or certain treatment, the medical assistant can either provide needed care at the time of the visit (such as drawing blood for lab tests) or make referrals for more complex care (such as colonoscopies).

    The clinical decision support system allows the medical assistants to address many of these alerts before the physicians enter the exam rooms, which enables the physicians to spend more time on other aspects of care. “The EHR helps our focus on a team approach, where the doctors do not have to do everything, and the other staff can do a lot,” says Frank Maselli, MD, co-founder of Riverdale Family Practice.

    Assessing Quality

    For each physician, an EHR dashboard shows the practice’s performance on clinical quality measures necessary for meaningful use. Certain quality measures have improved since the EHR implementation, including adult and child immunization rates. Also, physicians value the ability to see time trends in patients’ vitals or lab values, such as HbA1c, over time.

    Patients who have signed up to use the patient portal also are able to track their lab results and compare their progress over time. To encourage more patients to be actively involved in their care, the family practice plans to increase training for patients to promote increased use of the patient portal.

    Patients can also access the portal and web-based educational resources in Riverdale Family Practice’s waiting area, which are aimed to improve self-management. Riverdale Family Practice was an early participant in the Primary Care Information Project’s Patient Engagement and Education Kiosk (PEEK) project, which outfits medical providers in the five New York City boroughs with tablet kiosks in waiting areas or exam rooms.

    In addition to reviewing their records at the kiosks before their appointments, patients also have access to the kiosks after they see their physician. As a result, patients are able to use portal capabilities or review disease- or condition-specific educational resources based on information shared during their physician appointment.

    Anticipating Next Steps

    Maselli and his colleagues are looking forward to greater interoperability between EHRs at different practices and facilities that are treating the same patient. This will be especially important as the healthcare system moves toward more coordinated care through new structures such as accountable care organizations (ACOs). In fact, Riverdale Family Practice has joined an ACO sponsored by Montefiore Medical Center that may work toward data exchange among all of the providers involved in the ACO.

    This article is adapted from “New York Practice Uses EHR Functions for Quality Improvement,” HealthIT.gov.