Are your spidey senses tingling yet? Meaningful Use Stage 2 attestations are right around the corner, and while Stage 2 isn’t the Green Goblin or Doctor Octopus (I promise!), Meaningful Use (MU) can seem like the villian when it comes to remembering what to document, when to document it, and how to document it to get it to count.
So, if Stage 2 is the villian, guess who gets to be the superhero?
Let’s start by taking Uncle Ben’s advice, “With great power comes great responsibility.” And the first responsibility you’ll have as “MU Man” or “MU Woman” is learning everything you can about the requirements for attestation.
We will soon be posting a training presentation (eligible for CME credit) which will detail what and how to document the Stage 2 requirements, but as a quick summary, below are the 17 core measures and 3 menu measures that are required for Stage 2.

Stage 2 Core and Menu Measures

Core Objectives (17 total)
(1) Use computerized provider order entry (CPOE) for medication (>60%), laboratory (>30%) and radiology orders (>30%) directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.

(2) Generate and transmit permissible prescriptions electronically (>50%).

(3) Record the following demographics: preferred language, sex, race, ethnicity, and date of birth (>80%).

(4) Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI (>80%).

(5) Record smoking status for patients 13 years old or older (>80%).

(6) Use 5 clinical decision support interventions to improve performance on high-priority health conditions (these must be related to Clinical Quality Measures) AND enable and implement drug-drug and drug-allergy checks.

(7) Provide patients the ability to view online, download, and transmit their health information within four business days of the information being available to the EP (>50%).

(8) Provide clinical summaries for patients for each office visit (>50%).

(9) Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.

(10) Incorporate clinical lab-test results into Certified EHR Technology as structured data (>55%).

(11) Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

(12) Use clinically relevant information to identify pa­tients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference (>10%).

(13) Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient (>10%).

(14) The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.

(15) The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral (>50%).(16) Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice (Yes/No).

(17) Use secure electronic messaging to communicate with patients on relevant health information (>5%).

Eligible Professional Menu Objectives (3 of 6)
(1) Record electronic notes in patient records (>30%).

(2) Imaging results consisting of the image itself and any explanation or other accompanying information are acces­sible through CEHRT (>10%).

(3) Record patient family health history (1st degree rela­tive) as structured data (>20%) .

If you’re still learning the ropes on how to use your su­perpowers (a.k.a. EHR documentation skills), this Stage 2 summary may have you rethinking your superhero status, but no one ever promised saving the world was easy.
And I haven’t even mentioned CQMs!

If you aren’t familiar with AMC’s television series The Walking Dead, I would suggest you catch up before the start of the next season in October. For fans of the show, Season 4 ended March 30th, and the next few months will be filled with anxious anticipation for the Season 5 premiere, which will reveal the fate of the show’s characters who are trying to survive in the midst of a full-blown zombie apocalypse.
While a show about zombies may seem a far cry from learning how to use an EHR meaningfully (or maybe not), there are some surprising lessons from the show that EHR Meaningful Users may find helpful (or at least interesting).

1. There is no escape for anyone.  One thing that the characters learn quickly in The Walking Dead is that zombies are everywhere. Private homes or public buildings, underground or underwater, in the light of day or in the light of the moon — it doesn’t matter where the survivors seek refuge, zombies have a knack for showing up, and, frankly, it’s unnerving. For many healthcare providers, they feel the same way about “meaningful use”— it’s all consuming. Learning how to document in an EHR is tough enough, let alone having to document a certain way as to not alert the chomping mouths of the administrators and their weekly reports. So if there’s no escape, how do you survive? Mostly, surviving requires assimilation. The characters learn what it takes to kill the zombies while at the same time studying what triggers their attention and what it takes to hide from them. That’s not saying healthcare providers should learn how to kill or to hide from the administration (even if it does seem tempting at times). More along the lines of accepting your situation, studying what it takes to document correctly, and developing strategies to do it faster.

2. Even a prison can be a refuge.  At the beginning of Season 3,  after a long, hard winter of running on empty, Rick Grimes (the male protagonist of the series) and crew finally find a place to rest and refuel (and perhaps even reside?). And where else but a prison?! While we discover later in the series that the prison isn’t the perfect sanctuary, it does provide them with a temporary refuge where they have time to recover. Likewise, Meaningful Use may seem like a prison sentence for providers who have never had to document in an EHR before now, but in some ways, Meaningful Use has provided EHR users a means of protection in an industry that demands high standards be met for quality patient care. At least healthcare providers can be assured that when purchasing EHR hardware and software, the vendors must design them to meet Meaningful Use criteria in order to be a certified product. Additionally, while the Meaningful Use program isn’t perfect, participants do receive funding from the program, which should help them pay for the cost of implementation. For a time, their HIT initiatives are covered (or at least partially); every now and again a zombie sneaks into the prison.

3. We must have hope.  If my favorite characters keep dying (in very gruesome, dismal ways) and the zombie apocalypse apparently has no end in sight, why do I and millions of other fans keep watching every Sunday night, glued to our sets for the full hour, the only show that, as one friend pointed out, is watched in real time versus hours or days later on the DVR (yes, we actually sit through the commercials)? Perhaps it’s because we still have hope—hope that those who are left will find a safe haven, a place to “live” once again rather than just exist. Better yet, hope for eradication of the virus that started the whole apocalypse and continues to be a constant threat to the survival of the human race. Perhaps the best lesson healthcare providers can take away from the show is they must have hope—hope that all of their efforts, that all of their struggles, that all of their time and money invested will pay off in the end and that patient care will be improved. 

CMS Extends Timeline for EHR Incentive Program
A few weeks ago, the Centers for Medicare & Medicaid Services (CMS) proposed a new timeline for the implementation of meaningful use. The new timeline extends Stage 2 through 2016, and Stage 3 will begin in 2017 for providers who have completed at least two years in Stage 2. The extension was made for two reasons: one, to allow CMS “to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2”; and, two, to have access to the data from Stage 2 to inform policy decisions for Stage 3.
The three stages are set up to transition participants, from creating information in Stage 1, to exchanging information in Stage 2, to improving outcomes in Stage 3. 

According to CMS, the new timeline would have several benefits:

• More analysis of feedback from Stage 2 
• More available data on Stage 2 adoption and measure calculations – especially on new patient engagement measures and health information exchange objective
• More consideration of potential Stage 3 requirements
• Additional time for preparation for enhanced Stage 3 requirements
• Ample time for developers to create and distribute certified EHR technology before Stage 3 begins, and incorporate lessons learned about usability and customization.

CMS plans to release a notice of proposed rulemaking for Stage 3 in the fall of 2014. The final rule with all requirements for Stage 3 would follow in the first half of 2015.  All comments from those individuals with a direct interest will be “reviewed and carefully considered” before the final rules are released.

What this means for Quillen Providers
Although this announcement doesn’t immediately affect us, it does give us a little more breathing room, as many of our providers were early participants in the program. For any provider who started the program in 2011, the new timeline will look similar to the following:

2011  Adopt, Implement, Upgrade
2012  Demonstrate 90 days of Stage 1
2013  Demonstrate a  Full Year of Stage 1
2014  Demonstrate 90 days of Stage 2
2015  Demonstrate a Full Year of Stage 2
2017 Begin Stage 3

Not all of our providers started in 2011, so your particular timeline may look a little different. CMS offers a timeline tool  that participants can use to see a personalized timeline.
As we enter a new year and start working on a new timeline, perhaps the song below won’t be as applicable, but just in case you are still in a panic about Meaningful Use, here’s a song for you!

I was panicking when I wrote this
Forgive me if it goes astray
But when I got to work this mornin'
Could of sworn it was Attestation Day.

The computer screen was all black
There were patients waitin’ everywhere
Tryin' to get relief from sickness
But CMS didn’t seem to care.

'Cause they say two thousand one three
Stage One is over, oops out of time
So today I’ve got to click like it's 2014
(Sorry, couldn’t make it rhyme)

I was panicking when I wrote this
So sue me if I go too fast
Stage 2 is not a party
And clicking is not a blast.

The EHR is all around us
My eyes say too much screen time
But if I gotta click
I'm gonna make it by the deadline.

Yeah, they say two thousand one three
Stage One is over, oops out of time
So today I’ve got to click like it's 2014.
(Sorry, couldn’t make it rhyme)

Lemme tell ya somethin'
If you didn't come to document
Don't bother seeing patients
We got CMS wanting data
And, doc, we’re runnin’ outta time!

In a recent Medscape Family Medicine article by Brandon Cohen, “Making EHRs Less Intrusive and Annoying for Patients,” Cohen points out an all too obvious fact, that some physicians see electronic health records (EHRs) as “a giant headache” and “a barrier to good relationships with patients.” Cohen adds, however, that other providers see the EHR as a valuable tool that helps with “efficiency and accuracy” and doesn’t have to impede the doctor/patient relationship. Some of the comments shared by frustrated physician EHR users may be echoed in your office:

• "EHR has turned us from MDs into data entry clerks! We have gone from being a medical practice to an IT firm." 
  
• "I feel less satisfied at the end of the day now. When patients are all gone, I'm typing, spell-checking, and doing autocorrections." 
• "The measures of quality [in EHR] are based on checked boxes, not real outcomes. They have to be, or it fails. Simple is always better!"
• "The most important keystroke is to push the PC aside and face the patient directly."
• "I live in a town that has passed legislation criminalizing texting and driving. A driver is more impaired and distracted when texting than when intoxicated. EHRs and the practice of medicine should be no different. Do you really believe that your physician is actually concentrating on the patient in front of them while their attention is primarily focused on entering data in a computer?"
• "It's time to tell the practice managers, insurance companies, and efficiency consultants that patients expect and deserve a real physician who is a caring human being and is able to take the time and provide the human element that is a major dimension of healing."

These sentiments of frustration are obviously felt nationwide, but what makes the difference for those physicians who appreciate having an EHR? Is it a different generation of users or a different specialty? Could it be the difference in the EHR system or the workflow set up? It may be that all of these factors affect attitudes, but Cohen shares some suggestions from other physicians for making EHR more patient friendly, and, to that end, more tolerable. 

Improving the EHR Experience
Doctors who have found satisfaction with their EHR product offered suggestions to their frustrated colleagues for making the EHR less intrusive. 

Let the patient interact with the computer, too. "[Older] patients feel much more comfortable with the computer when I pull up their actual scans on the monitor and use them to explain their disease...For many patients, the computer is not only an accepted but welcome presence." (Oncology)

Identify the benefits of using an EHR and what works well. "I have a lot of stuff in the current note that used to be buried in the chart (or omitted). Every patient gets a printout of today's interim history and the proposed plan, as well as a list of meds and diagnoses." (Psychiatry)Bigger might be better. "I have a 32-inch monitor screen on the wall and wireless keyboard and mouse. It sucks the patient into their record and is unmatched for patient education." (Primary Care)

Switch the workflow and take notes. "I leave the computer out of the exam room and take notes as necessary, then complete the EHR after the interview, while my assistant is performing her tasks with the patient." (Gastroenterology)

Enter what’s necessary first, then use pen and paper.  "I inform the new patient, 'I'm just going to get some background information, and then I will talk to you about why you are here.' Once the database is completed, I print off the sheets and conduct the history and physical in the same manner I have done for the past 38 years." (Internal Medicine)

Learn to touch-type. "I touch-type, which I highly recommend learning. I can maintain eye contact while entering their history." (Internal Medicine)

Cohen noted that most physicians are not completely satisfied with current EHR technology, but many users are hopeful about what the future will bring to healthcare technology, especially as improvements are made to free up the physician to interact with patients.  
Of course, as one physician pointed out, there is one generation of patients that probably aren’t bothered at all by the presence of the computer:
"They [teenagers] won't notice you looking at a screen because their peripheral vision isn't that good, and they never break their texting trance. ...This EHR [problem] may be a transient issue; it certainly doesn't bother the younger generation."
Perhaps the issue is transient, as the provider above suggests, especially as computers and other technologies saturate our society and lives, but insights from successful users may be beneficial as we transition to this new way of medical record keeping and documentation.  

In a recent study conducted by RAND Health, “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy,” I think it’s no surprise to most EHR users that EHRs were listed among those factors, and, dare I say it, meaningful use was listed as well.

But that’s not to say that EHRs and meaningful use were only listed as adherences to professional satisfaction; in fact, the study shed some light on how physicians would like to see both EHRs and government programs improved. 

The study, commissioned by the American Medical Association, is being used as part of the group’s objective to “advance health care delivery and payment models that enable high-quality, affordable care and restore and preserve physician satisfaction.” The hope in seeking such change is to produce a better health care system with highly motivated physicians. RAND sought to “identify high-priority determinants of professional satisfaction,” especially as more physicians are becoming affiliated with hospitals and larger delivery systems. The data was gathered from 30 physician practices in six states using both surveys and interviews. Notably, researchers discovered that physicians who considered themselves or practices as providing high-quality care reported better professional satisfaction. Primary care physicians in particular were most frustrated when “demands for greater quantity of care” cut down on the time spent with patients, and in some cases, distracted them from delivering the quality of care being measured. 

Listed as both “promising” and “frustrating,” the major concerns about electronic health records were interoperability between systems and the amount of provider time involved in data entry. Physicians surveyed liked the “idea” of an EHR but the “cons” of current systems far outweighed the “pros”:

Pros 

• accessibility to patient records 
• improvements in quality of care 
  

Cons 

• poor usability, 
• time-consuming data entry, 
• interference with face-to-face patient care, 
• inefficient and less fulfilling work content (creativity),
• inability to exchange health information, 
• degradation (damaging ) of clinical documentation.
  

In addition to EHRs, another source of frustration for physicians was the cumulative burden of regulations, and, at the time of the study, had “meaningful use" rules for EHRs topping the list. 

Although the AMA’s intent for the RAND study is commendable, the study probably didn’t reveal anything too new for current users of EHRs or participants in the meaningful use incentive pro- gram. Perhaps, however, if the study is placed in the hands of those persons designing or implementing EHRs or writing or passing laws concerning the use of EHRs, the study may prove useful, namely concerning the recommendations made about improving professional satisfaction. Recommendations of the study specifically concerning EHRs and regulations included the following:

1. Better EHR usability should be an industry-wide priority and a precondition for EHR certification. 
2. Reducing the cumulative burden of rules and regulations may improve professional satisfaction and enhance physicians' ability to focus on patient care.

So, until these recommendations are implemented, what should physicians and healthcare providers do to improve their current situation? I would first recommend a change of tune.

If you’ve been humming along to the Rolling Stones,

And he’s tellin’ me more and more
About some useless information, 
Supposed to fire my imagination.
I can’t get no, oh no, no, no,

Hey, hey, hey, that's what I say. 
I can't get no satisfaction.
I can't get no satisfaction. 
Cause I try and I try and I try.....

How about a different song? 

At first, I was afraid, I was petrified
Kept thinking, I could never live without paper charts by my side.
But then I spent so many nights thinking, how you did me wrong,
And I grew strong, and I learned how to get along with the EHR. 

It took all the strength I had not to fall apart. 
Kept trying hard to mend the pieces of my broken chart,
And I spent, oh, so many nights just feeling sorry for myself. 

I used to cry, but now I hold my head up high,
And you see me, somebody new!
I'm not that chained up little person still in love with paper charts. 

Oh, no, not I, I will survive!
Oh, as long as I know how to click, I know I'll stay alive.
I've got all my life to click, I've got all my knowledge to give.
And I'll survive, I will survive, I will survive! 

(Adapted from Gloria Gaynor’s I Will Survive.)

You may have already heard more than you care to about the topic, but like it or not, secure exchange of protected health information is required for HIPAA compliance. Not surprisingly, some of the required measures for achieving Stage 1 and Stage 2 Meaningful Use involve the secure electronic exchange of  patient health information.  Stage 2 Core Measure 17 “Use Secure Electronic Messaging” is a prime example:

The Objective is to use secure electronic messaging to communicate with patients on relevant health information.  A secure message must be sent using the electronic messaging function of the provider’s CEHRT by more than 5 percent of unique patients seen by the eligible provider (EP) during the reporting period. 

A Secure Message is defined as  “Any electronic communication between a provider and patient that ensures only those parties can access the communication. This electronic message could be 1) email, 2) the electronic messaging function of a PHR, 3) an online patient portal, or 4) any other electronic means. An EP or staff member can follow-up with a telephone call or office visit if deemed more appropriate to address the concerns raised in the patient’s e-message. And don’t get too panicking just yet if you’re thinking what a lot of other providers are thinking, “Yikes! Email from patients?!”. . .There isn’t a requirement that the EP must personally respond to electronic messages to the patient. Designated office staff can manage the email under the supervision of the physician.
As Quillen ETSU Physicians prepares to meet the requirements of this measure and to comply with the HIPPA Security Rule, we have started the process of registering our users in the Direct Project.  If you’ve been asked to send us your driver’s license and ETSU ID, then you’re on your way to being registered. The Direct Project offers providers a secure way to send protected health information, including clinical summaries, continuity of care documents (CCDs), and laboratory results, to other providers who also have a Direct address. Presently, we are participating in the most basic implementation of the Direct Project, a secure email system via an email client, which works just like regular email, but with an added level of security required to transport sensitive health information.
Over the next few weeks, some of our users will be receiving an email much like the one you see below. Once you receive it, you’ll be asked in another email by the EHR administrator to forward it to her. She’ll be providing you with additional information for using it later.
Admittedly, there are many changes going on in healthcare right now, which may have you feeling overwhelmed. But, what I keep reminding myself—as I try to muddle through and stay current in serving our users—is that these changes are being implemented for improved quality of patient care and, eventually, to make providing that care to our patients more convenient for everyone.
It wasn’t too long ago that we all heard the chime, “You’ve got mail!” as we logged into our AOL accounts through our dial-up modems (can you remember how slow that connection was?). Now we are blazing across the internet on our smart phones and tablets, with instant access to almost any information we need, including patient health records.
Healthcare technology’s day will soon arrive and all of the changes that are being implemented now will seem routine and outdated as we continue to move forward. Rather than having to leave voicemails, send faxes, call the pharmacy again and again, or wait on a patient’s return call, wait on a fax, or wait on the pharmacy to call you back, the exchange of secure information will be at your fingertips and as fast as you can say, “You’ve Got Secure Mail.”

Ever feel like the government is one big bully, forcing you to  click a box or else? If so, you aren’t alone. At a recent conference presentation I attended on EHR use, the presenter* revealed that a good portion of the providers at his practice feel bullied into using an EHR. Their comments included

•  “I don’t really care what the government wants me to do.”
• “I want to tell my story in my own way, in my own words.”
• “An EMR can never tell me how to practice medicine!”
• “I don’t really care what’s in the note so long as you leave my narrative alone.”
• “I’m not going to use it.”
  

Many of our Quillen ETSU providers have made similar comments, and who can blame them? Change is never easy, and when that change is implemented with the consequence of “or else,” it’s no wonder that many providers feel bullied into using an EHR.

But what strategies do we encourage our children to use when faced with a bully?  The most common strategy, but one that’s effectiveness has recently been questioned, is to “walk away.”  And questioned rightfully so. A child who walks away from a bully doesn’t make the bully go away. And doctors who walk away—well, they’d just need to find another job, right? —because the EHR isn’t going away.

So what bully strategies do work?  Most experts encourage children to get involved with a another group. With positive peers around, the bully finds it harder to isolate the victim, and, often, the group’s positive influence becomes contagious, even to the point of affecting the bully.

To apply this same strategy to our EHR scenario works as well. Rather than providers giving up, walking away,  and joining the unemployment line, working with the EHR can have some positive outcomes on  our patient population.  With the entire staff on board, and negative attitudes put aside, consider the benefits of using the EHR:

• Patient lists can be generated for better tracking of patient populations, for instance, identifying cardiology patients with low ejection fractions but no ICD.
• Candidates for clinical research trials can be quickly identified.
• The accuracy of medication lists is improved. 
• Order tracking is improved and the cost savings from duplicate orders are passed along to the patient. 
  

Although this is a short list, there are many more benefits that can be added to it. So for those users who  have taken the attitude “If you can’t beat it, join it” or better yet, “I love it,” pass along your sentiments. 

And for those “victims” out there, adopt a new strategy and let  some positive peer pressure affect  you.

*Presentation by Scott Tuning, Clinical Information Systems Manager, New Mexico Heart Institute, Albuquerque, NM

One of my very favorite pediatricians (and she knows who she is) made the comment a couple of weeks ago that she thought her clinic should be winning a pizza party for something other than clicking a box to document education. She suggested that they should be winning for something like, well, quality patient care.

I absolutely agree with her. They should be awarded for quality patient care.

As I mentioned last month, I am a parent who truly appreciates the quality of care my children have received from them. And as an EHR analyst, I’ve been able to work with the clinic to help set up templates to document some of the grant initiatives they’ve been awarded recently (Ever heard about the ReadNPlay books?)  And when it comes to residency training, this group has really demonstrated their commitment to medical education and making sure that their residents are well prepared, not only for providing excellent patient care, but for also documenting excellent care in an electronic health record.

I say all of this—not to brag on the clinic again this month—but to suggest that checking a box and providing quality care can go hand-in-hand. Maybe we could’ve rephrased our award to be “Highest Percentage of Quality Care Education Documentation.” I little wordy, perhaps, but do you see what I’m getting at?

The Meaningful Use initiative wasn’t created to demean or devalue the care providers are already giving; it was designed, in part, to help document that care in a meaningful way, or, more specifically, in a way that can be pulled as data later—for research, for quality improvement, for education. It was also implemented to ensure providers are equipped with EHRs that are designed to be a secure tool for them, not just another database.

Admittedly, it isn’t a perfect program, and what new quality health initiative is? Yes, providers do have to spend more time clicking boxes, and, yes, the system freezes up sometimes, and, yes, there are “bugs” that creep around the system, just to get under our skin.

Not that these imperfections are directly Meaningful Use centered; in fact, most of the things users complain about are technology centered. How many times have you found yourself grumbling about your Smartphone being too slow or forgetting your online banking password? In fact, just a few days ago, I had to call my credit card issuer because their website locked me out…imagine that! But, I also can’t imagine not having my Smartphone, or not being able to check my bank account balance, or not being able to pay my bills online. I never want to balance a paper checkbook using canceled checks again. And I would guess that none of our users can imagine using a paper chart again.

But as we start preparing for the next stage of Meaningful Use, it’s interesting to look at how this next stage is trying to improve from the first stage of the program and really make use of developing technologies. According to CMS, Stage 2 Meaningful Use was designed to support “the aims and priorities of the National Quality Strategy. Specifically, Stage 2 meaningful use criteria…encourage[s] the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible." As part of the Affordable Care Act, the National Quality Strategy is a national endeavor to “align public and private interests to improve the quality of health and health care for all Americans.”

It’s guided by three aims to provide better, more affordable care for people and communities, as well as six priorities:

• Making care safer by reducing harm caused in the delivery of care.
• Ensuring that each person and family is engaged as partners in their care.
• Promoting effective communication and coordination of care.
• Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
• Working with communities to promote wide use of best practices to enable healthy living.
• Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.
  

Let’s use patient education to illustrate how these priorities work. For Stage 2, core measure #13 requires using a certified EHR to identify and to provide patient-specific education for more than 10% of unique patients. As an improvement upon Stage 1, our EHR will be required for Stage 2 to identify appropriate educational resources for the patient, based on either his or her problem list, medication list, or laboratory test results.

Although the material doesn’t have to be produced from the EHR, the EHR will be required to become a useful tool for the practitioner, rooted in the third and fourth priorities mentioned previously: he is assisted with, one, effective communication and, two, effective prevention and treatment practices. With Quillen’s next major upgrade to Allscripts, our users won’t just be clicking a box to say they provided education; our system will alert them that patient education might be appropriate and is available for the patient. 

This is not to say that my favorite pediatrician needs to be reminded to educate her patients; she has been practicing long enough that patient education is second nature to her. But the convenience of having the education available from within the system and available in an electronic format that can be sent to a patient portal is a tremendous advantage of an EHR. 

Some of our providers are already taking advantage of the patient education tool now. For instance, rather than just click “Education provided,” one of our internal medicine providers selects a diet plan (when appropriate) that is loaded in the system and prints it out for the patient before he or she leaves.  

Another great example, one of our surgeons orders and then prints education about laxatives so that patients can understand the different options. The EHR Team can also add educational material if a clinic or provider requests it. 

Kudos to these providers for attempting to use the system’s tools. It’s definitely not the easiest system to use, and, again, the system is far from perfect. But why not take advantage of the benefits it does offer? 

I have written about workflow, proper documentation, and clinical quality measures over and over, but my perspective has always been a little one-sided until recently.  Always writing from the clinical staffs’ viewpoint, I never really considered how the patient might perceive the implementation of our EHR and all of the workflow changes that have come about as a result of our EHR incentives programs, like Meaningful Use or PQRS.  However, with the recent illness of my middle daughter, I’ve gained a lot of valuable patient insight (albeit not from the best of circumstances), and I’m very appreciative of the learning opportunity.

So exactly what have I learned?

1. Computers can be glitchy, but they provide a lot of valuable information. While at the hospital and at follow-up appointments with Anna, there were a few times that the computers froze or caused a problem, but, honestly, not that often. And given the alternative —of not having Anna’s information readily available and having to wait on records to be faxed—I’ll take the occasional glitch. Anna has seen multiple providers during the past few months, and with all them having access to her electronic chart, it put my mind at ease.

2. Computers do get in between the provider and patient, but it isn’t all that bad. I have heard several clinicians say that they feel like the computer gets in between them and the patient. And I have also heard patients say the same thing. But from what I observed during Anna’s experience, it’s not really that intrusive. Sure, you have to spend some time entering information, but once the information was entered, all of her providers spent time examining her and talking to her directly. It definitely wasn’t any different than writing down the information on paper. I discovered that most everyone who saw her has developed a balance in using the computer and seeing the patient.

3. An EHR saves the patient money. As mentioned in #1 above, when providers share the same record, it’s time gained, but it’s also money saved. All of Anna’s orders (labs, imaging, etc.) were shared by all of her providers, and no duplicate tests were unnecessarily ordered, saving me money.

4. The Clinical Summary is nice. First of all, let me say that Crystal, one of the check-in staff at Pediatrics, does an awesome job. She never forgot to ask us if we wanted a clinical summary of our visit. Although I didn’t need her to print it for all of Anna’s visits, the document has come in handy at other times. With so many medications and orders and diagnoses, it’s difficult to keep track of all that information, especially during a stressful acute illness. Thank you, Crystal, for always asking, because there are times when this mom forgets things. 

5. Quillen ETSU Physicians are wonderful physicians. Although I’ve taken advantage of Anna’s illness for inspiration to write, I hope everyone will indulge me. The most valuable perspective I gained during this experience is how wonderful our physicians and staff are. Anna has received the best of care, and I can’t say enough how appreciative I am for everyone who has helped her. To everyone at ETSU Family Medicine in Johnson City, ETSU Pediatrics, and ETSU Surgery, thank you so much for providing the best of care. You rock (the EHR, too)!