Orthopedic practices around the country are considering whether to implement electronic health records and begin the process of achieving meaningful use of those systems. Barbara Sack, Executive Director at Midwest Orthopaedics in Shawnee Mission, Kan., helped lead her practice to successfully implement the SRS EHR system and attest to meaningful use. Here, Ms. Sack offers her expertise on the process. Robert Sharpe, MD, is one of the physicians at Midwest Orthopaedics and also offered some thoughts.
Question: Why did you decide to move forward with pursuing meaningful use requirements?
Barbara Sack: Until about a year ago, we were reluctant to pursue meaningful use. We thought it would cost more than we would recoup because of the onerous requirements, and in particular, specific details related to orthopedics. We weren't going to do it unless or until we felt that we had an EHR that could meet the requirements without hurting our workflow. Once we were satisfied that our EHR would help us meet meaningful use in a non-burdensome way, we decided to go for it.
Robert Sharpe, MD: Another reason we decided to pursue meaningful use is that we wanted to go through the learning curve before there was a penalty. If there would be a potential bonus, so much the better. However, since there is going to be a penalty, we wanted to know how to do it successfully and correctly before that time comes.
BS: There are some people who are betting on another election cycle to change the requirements. That would be great, but I don't want to bet on that. We were ready for the requirements and we were successful in our implementation of an EHR and in our pursuit of meaningful use.
Q: Have you seen any improvements in the practice as a result of meeting the meaningful use requirements?
BS: I think that any time you increase your ability to mine data from your system you incrementally improve the overall care you provide. I can see where some specialties may find further benefit — in our case meeting the requirements still tips the scale slightly towards increased administrative burden — but if you have the right EHR and the support of the EHR vendor like we did, it is definitely easier.
Unfortunately, in today's healthcare environment, we are dealing with payors continually adding administrative requirements for providers — which translates to additional costs — while simultaneously providing less compensation. It's hard for people outside of healthcare to believe there is a business industry that continually has additional cost requirements and at the same time is paid less; that's not a sustainable business model. Medicine isn't going away, because everyone needs medical care. We are challenged in this industry having to continuously find better and more efficient ways of doing things because we have no other choice.
Q: What were the biggest challenges you face in order to meet meaningful use requirements?
BS: The biggest challenge was determining workflow — who does what? Another big challenge was trying to interpret exactly what the requirement was for each measure, and the best way to satisfy it. For example, in orthopedics we measure patients' height, weight and BMI, but we don't always take their blood pressure. However, to meet the meaningful use requirement, you can't attest to one of these unless you attest to all three. This was a change that brought new costs to our orthopaedic practice. We had to invest in new equipment and train staff in how to take blood pressure.
We mitigated some of that by explaining to the clinical staff that taking blood pressure was something additional they had to do, but as a bonus they don't have to calculate BMI anymore, because the EHR does that automatically.
RS: We physicians really relied on our staff to step up and make sure that things like taking blood pressure and printing patient education materials out of the system got done according to the requirements, and they did a great job. But for the physicians it was a fairly seamless and painless experience.
Q: How has your practice changed as a result of achieving meaningful use?
BS: There is the additional administrative burden to keep track of how we are doing and we run reports regularly for the physicians and staff. As far as changing the practice, it really has not greatly changed the way the doctor sees the patients, which is huge for us. In selecting SRS as our EHR and deciding to qualify for Meaningful Use, our goal was to maintain the physicians' efficiency and patient interaction. It has not changed the quality of care — it was excellent before and now we can demonstrate that to anyone.
RS: There were many good reasons to transition to an EHR system, and electronic prescribing has been a good example because it's more efficient, secure, legible, and it checks for errors. It's pretty easy to quantify the benefits of that. I would say that our EHR system has made us more efficient and improved our practice. Qualifying for Meaningful Use has primarily allowed us to validate this.
Q: What words of wisdom do you have for other practices about to embark on the process of achieving meaningful use?
BS: Selecting the right EHR helps a lot. SRS was extremely committed to supporting us. Their Government Affairs department and support teams went above and beyond, providing us with assistance, educational webinars and demonstrations, and any kind of support we needed to overcome the challenges that arose while meeting the meaningful use requirements.
Also, completing the preparation work is important before beginning the process. Have an idea of what your workflow will be to the extent that you can and network with your peers that have already successfully demonstrated meaningful use. We have had groups come through to see our workflow with our specific EHR. They want to know what our processes are and how it changes what we do. Networking with your peers is one of the best things you can do in order to prepare for implementation of an EHR and tackling meaningful use.
Q: What is the key to successful meaningful use attestation?
BS: Quality checking by monitoring weekly reports from the EHR. You just have to stay on top of the reports so if there is a problem area you involve the staff and you can fix it right away. Some groups might have an IT person to work on that. In our group, that person was me. Most groups won't have an IT person, so the practice executive will do that.
If the practice executive is able to involve the staff and stay on top of the reports, attestation will be successful. We never got into a position where we wouldn't be able to overcome a deficit because we regularly checked in from the first day to make sure we were hitting our targets.
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Barbara Sack: Until about a year ago, we were reluctant to pursue meaningful use. We thought it would cost more than we would recoup because of the onerous requirements, and in particular, specific details related to orthopedics. We weren't going to do it unless or until we felt that we had an EHR that could meet the requirements without hurting our workflow. Once we were satisfied that our EHR would help us meet meaningful use in a non-burdensome way, we decided to go for it.
Robert Sharpe, MD: Another reason we decided to pursue meaningful use is that we wanted to go through the learning curve before there was a penalty. If there would be a potential bonus, so much the better. However, since there is going to be a penalty, we wanted to know how to do it successfully and correctly before that time comes.
BS: There are some people who are betting on another election cycle to change the requirements. That would be great, but I don't want to bet on that. We were ready for the requirements and we were successful in our implementation of an EHR and in our pursuit of meaningful use.
Q: Have you seen any improvements in the practice as a result of meeting the meaningful use requirements?
BS: I think that any time you increase your ability to mine data from your system you incrementally improve the overall care you provide. I can see where some specialties may find further benefit — in our case meeting the requirements still tips the scale slightly towards increased administrative burden — but if you have the right EHR and the support of the EHR vendor like we did, it is definitely easier.
Unfortunately, in today's healthcare environment, we are dealing with payors continually adding administrative requirements for providers — which translates to additional costs — while simultaneously providing less compensation. It's hard for people outside of healthcare to believe there is a business industry that continually has additional cost requirements and at the same time is paid less; that's not a sustainable business model. Medicine isn't going away, because everyone needs medical care. We are challenged in this industry having to continuously find better and more efficient ways of doing things because we have no other choice.
Q: What were the biggest challenges you face in order to meet meaningful use requirements?
BS: The biggest challenge was determining workflow — who does what? Another big challenge was trying to interpret exactly what the requirement was for each measure, and the best way to satisfy it. For example, in orthopedics we measure patients' height, weight and BMI, but we don't always take their blood pressure. However, to meet the meaningful use requirement, you can't attest to one of these unless you attest to all three. This was a change that brought new costs to our orthopaedic practice. We had to invest in new equipment and train staff in how to take blood pressure.
We mitigated some of that by explaining to the clinical staff that taking blood pressure was something additional they had to do, but as a bonus they don't have to calculate BMI anymore, because the EHR does that automatically.
RS: We physicians really relied on our staff to step up and make sure that things like taking blood pressure and printing patient education materials out of the system got done according to the requirements, and they did a great job. But for the physicians it was a fairly seamless and painless experience.
Q: How has your practice changed as a result of achieving meaningful use?
BS: There is the additional administrative burden to keep track of how we are doing and we run reports regularly for the physicians and staff. As far as changing the practice, it really has not greatly changed the way the doctor sees the patients, which is huge for us. In selecting SRS as our EHR and deciding to qualify for Meaningful Use, our goal was to maintain the physicians' efficiency and patient interaction. It has not changed the quality of care — it was excellent before and now we can demonstrate that to anyone.
RS: There were many good reasons to transition to an EHR system, and electronic prescribing has been a good example because it's more efficient, secure, legible, and it checks for errors. It's pretty easy to quantify the benefits of that. I would say that our EHR system has made us more efficient and improved our practice. Qualifying for Meaningful Use has primarily allowed us to validate this.
Q: What words of wisdom do you have for other practices about to embark on the process of achieving meaningful use?
BS: Selecting the right EHR helps a lot. SRS was extremely committed to supporting us. Their Government Affairs department and support teams went above and beyond, providing us with assistance, educational webinars and demonstrations, and any kind of support we needed to overcome the challenges that arose while meeting the meaningful use requirements.
Also, completing the preparation work is important before beginning the process. Have an idea of what your workflow will be to the extent that you can and network with your peers that have already successfully demonstrated meaningful use. We have had groups come through to see our workflow with our specific EHR. They want to know what our processes are and how it changes what we do. Networking with your peers is one of the best things you can do in order to prepare for implementation of an EHR and tackling meaningful use.
Q: What is the key to successful meaningful use attestation?
BS: Quality checking by monitoring weekly reports from the EHR. You just have to stay on top of the reports so if there is a problem area you involve the staff and you can fix it right away. Some groups might have an IT person to work on that. In our group, that person was me. Most groups won't have an IT person, so the practice executive will do that.
If the practice executive is able to involve the staff and stay on top of the reports, attestation will be successful. We never got into a position where we wouldn't be able to overcome a deficit because we regularly checked in from the first day to make sure we were hitting our targets.
More Articles on Orthopedic Practices:
Hospital Employment vs. Private Practice: What Makes Sense for Orthopedic Surgeons
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