July 01, 2011
By Cori Ast
As Jennifer Brull, MD, enters an exam room, her hands are free to greet her patient with a warm handshake. That's because, unlike many doctors, Brull isn't holding a clipboard with the patient's chart. Paper charts are a thing of the past at Plainville Medical Clinic, which documents patient visits with electronic health records (EHRs) that Brull can call up on a password-protected, networked computer in the exam room.
Brull, a family physician, can enter her diagnosis, treatment and other health information into the computer during the visit. Then she can print up a summary -- for the patient, not for her files.
"Each patient encounter is much more comprehensive. I no longer have to remember things about visits that might have been six months ago or more -- the computer remembers for me," Brull says.
The EHR system at Plainville Medical Clinic improves patient care and physician efficiency, but it also qualifies Brull for up to $63,750 in Medicare incentive payments. The payments are given to registered physicians and hospitals who engage in ""meaningful use"" of EHRs, which requires physicians to use the technology to improve patient care in a measurable manner. Some of these measurements include tracking preventive health screenings and behavioral information, such as tobacco use, that often influence patient health.
As of mid-May, only 1,026 providers in the nation had registered for the payments, out of a possible 56,599 that have demonstrated ""meaningful use."" Brull was one of the earliest adopters -- and the first certified ""meaningful use"" physician in Kansas.
"It's cool to be the first doctor in Kansas, but the best part of meaningful use is that, in the process, I improved the way I take care of my patients," Brull says. "And that's what''s key -- my patients get better care."
That better care has saved lives, too, according to Brull, who graduated from the KU School of Medicine in 1998.
For example, Brull thought she was doing a great job of talking to her patients about colon cancer prevention. However, when Plainville Medical Clinic implemented an EHR system, Brull realized her baseline measures for colon cancer screening were a paltry 43 percent.
"Anecdotally, I thought I was doing a great job of screening my patients for colon cancer. In reality, I wasn't," Brull says. In the two years she has been using EHRs, the percentage of her patients who are screened regularly for colon cancer has jumped to 85 percent. Brull has also caught three cases of colon cancer so early that the patients did not need chemotherapy. Those cases, she says, might have been missed if she was still screening fewer than half of her patients.
In fact, improved quality of care is why Brull and the physicians at Plainville Medical Clinic paid the hefty start-up costs to implement their EHR system, which went live in 2008. Despite the substantial investment, the EHR system at Plainville Medical Center has already paid for itself in increased physician productivity.
"It's just easier to see patients in the electronic world," Brull explains.
The financial incentives for EHRs extend beyond increased productivity. Brull has already received her first $18,000 Medicare incentive payment. The payments, which are authorized under the American Recovery and Reinvestment Act of 2009, will continue through 2016 for Medicare-based payments and through 2021 for Medicaid-based payments.
In 2015, however, punitive measures will go into effect for physicians and hospitals choosing not to comply with "meaningful use" of EHRs. Those providers will receive less money from Medicare reimbursement for providing the same services as certified "meaningful use" providers.
Karl Koob, chair of health information management at the University of Kansas School of Allied Health, says that the Center for Medicare and Medicaid Service''s carrot-and-stick approach is necessary because collecting the data on a national scale is critical for improving the U.S. health care system.
Although physicians benefit from the government''s push to adopt EHRs, many practices still haven't switched to electronic records. Anna Johnson, MET, clinical assistant professor of health information management at KU School of Allied Health, believes the hesitation, particularly among rural physicians, is due to in large part to the high start-up costs and the drastic changes EHRs can have on a physician''s work day.
"Small physician practices don''t have as many resources," Johnson says. Because implementing an electronic health record system is resource-intensive, the uncertainty of success can leave doctors waiting on the sidelines.
Brull believes that cost isn't the largest barrier. Instead, she says, it's a lack of support.
"I think when doctors say they're not financially able to implement an EHR, it has to do a lot more with the culture that is in place in the office. If you have people who believe it won't work, then it won''t," Brull says.
Brull and the physicians at Plainville Medical Clinic believed an EHR system could work for their practice -- and it does. Today, Plainville's patients can access their health records online, email their physicians with questions and receive overall better care thanks to the EHR system. Brull and the other physicians spend less time on paperwork and more with patients. The EHR system has also reduced the number of late nights in the office, leaving more time for family. A meaningful change indeed.