4 MU Tips from a Multispecialty Practice

This article appears in the April, 2012 issue of The Doctor's Office.

For the most part, the first group of providers to qualify for Stage 1 of the meaningful use regulations in 2011—and deposit incentive checks in the bank—were early adopters of electronic health records such as Old Hook Medical Associates, LLC in Emerson, NJ, a multispecialty practice that implemented its EHR in 2007.  

OHMA has one location and 20 providers, including full- and part-time positions and nurse practitioners. It began using a commercial EHR solution in 2007. "That was essentially our first real EHR," says Edward Gold, MD, president of OHMA, as well as an oncologist and hematologist. "We had been using a medical manager product and were using some of the EMR capabilities that it had, which were limited. But we really weren't fully electronic until 2007."

OHMA began its 90-day meaningful use ­attestation period on January 1, 2011. It submitted its data on April 19, 2011, qualified for everything it submitted, and received a $180,000 incentive payment in May 2011.

The practice submitted data for 10 physicians. OHMA has some part-time physicians who didn't qualify because they only work a couple of days per week and OHMA isn't their primary practice, Gold explained. 

He offers the following advice to practices considering MU attestation: 

1. Don't accept pushback.
Gold says OHMA made a corporate decision to switch from paper to EHRs and didn't accept opposition from its physicians. As such, the physicians didn't get to choose whether to use the technology.

"We said, 'Okay, if you want the chart, it will be in the medical records room but it won't be delivered to your desk anymore," he explains. "We made it inconvenient to use the paper chart, and pretty quickly the physicians found it easy to use the electronic medical record."

2. Adopt the system, whichever you choose, wholeheartedly.
OHMA uses every capability its EHR system offers, including the health maintenance portion, says Gold. "We went into it with both feet," he says. "The software is designed to be used as a whole unit. While you can pick and choose what you want to use with some of these programs, if you want to get the most out of it, you have to use the full functionality of the product—and that goes for any EHR product."

Gold says the one suggestion he gives to physicians in his community—many of whom know OHMA received its incentive payment—is not to adopt an EHR in bits and pieces. "If you try to piecemeal your way around because you like one thing and not another, or because you've done it this way for 30 years, ultimately you will have problems," he says. "If you adapt it wholeheartedly, you'll qualify." 

3. If also pursuing PCMH designation, combine efforts.
About one and a half years before pursuing meaningful use, OHMA made the decision to become a patient-centered medical home. OHMA was seeking a level-three PCMH qualification, and through that process, fulfilled many of the criteria for meaningful use—such as coordinating care, setting up a patient portal, and using e-prescriptions, says Gold.

In addition, the practice was already using the health management aspect of its HER, which provides recommendations, such as tests or screenings, for patients based on age or disease, as part of its effort to achieve the PCMH designation. OHMA was using practice analytics to identify diabetic patients with high blood sugar levels, for example, and it had processes in place for a nurse to follow up with those patients.

Because OHMA had these processes and the capability to collect data, "it became fairly easy to meet the level one meaningful use criteria," Gold says.

"The thing that we had the most difficulty with was giving patients the summary description of their visit," he notes. OHMA didn't previously offer patients a synopsis of their visit, so it had to change its work flow to meet that element of meaningful use.

Generating the summary description is an extra step in the process, and you need multiple levels of backup to make sure that it gets done, says Gold. "Estab­lishing it to be done on a consistent basis was the hardest part."

To ensure that patients received the summary description, physicians were trained to generate the summary, nurses were trained to follow up with physicians, and receptionists were trained to check that the summary was done and offer it to the patients.

"Now we give it to patients as they leave the reception desk," Gold says. Ironically, he estimates that 95% of patients don't even want the ­summary, and "the 5% who do want it are happy to go on to the patient portal and get it."

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OHMA launched its patient portal roughly one year ago and already has about 2,000 people signed up. Gold notes that the meaningful use regulations were unclear about whether offering patients an electronic visit summary via the patient portal is sufficient, or whether practices must offer a hard-copy summary as well. "We do both at this point because we want to cover our bases," he says.

4. Double the estimated training time.
Like any software product, whether it's an EHR or Microsoft Excel, the more familiar you are with the ins and outs of the software, the easier it is to get things done, says Gold.  The problem is that physicians are very busy and don't have a lot of patience, he says. "[Physicians] don't want to spend the time necessary to learn the product properly so that they can get the results that they want. They are used to telling an office manager to do this and it gets done," Gold says.

However, the meaningful use criteria require physician participation. "If the physicians are not going to have the time, patience, or wherewithal to participate in [meaningful use], don't expect to be able to qualify for it," he says. 

When it implemented its EHR, OHMA asked for additional training above and beyond what came with the product, says Gold. The practice had trainers on-site when the EHR went live. It also had a train-the-trainer program, where a number of people in the practice were trained first and became very familiar with the product so they could answer questions after the vendor's trainers left.

Physician practices need to spend time on implementation. Without a robust training plan, you can't succeed, says Gold. The challenge today is that "it is such a busy field right now with people buying products that the [vendor] companies are stressed to get [providers] implemented and get the training done," he says.

"Some [vendors] will say, 'We'll have you trained in a day and half—up and running—and you'll be good.' That is not true…whatever they tell you you need in training, double it."

This article appears in the April, 2012 issue of The Doctor's Office.