Electronic Medical Record Deployment: The Mercy Physicians Medical Group Experience
Health information technology (HIT) and specifically the electronic medical record is about to burst onto the scene in private practices throughout the nation. Buoyed by passage of President Obama’s stimulus package, the HITECH Act, the ARRA, and the recent award of a $15 million Beacon Grant to UC San Diego, San Diego practices need to start planning their paths through the IT maze, which is peppered with potential pitfalls.
This article is written from the experience of deploying a combined, single database electronic medical record (EMR)/practice management system in 10 primary care offices of various sizes in Mercy Physicians Medical Group (MPMG), a multispecialty IPA in central and south San Diego County. The group is involved in capitated care for both Medicare Advantage and commercial patients. Many participating physicians also see fee-for-service Medicare and serve commercial patients. Perhaps some pearls can be gleaned from our physicians’ experience to ease the transition for our colleagues.
Selection of a specific EMR product was accomplished by committee. MPMG’s management company, North American Medical Management, convened representatives from multiple IPAs under its umbrella about two years ago. An initial product selection was a nonstarter and was fortunately tested in a different IPA. The secondary selection proved to be an excellent decision. More than 25 practitioners are now using this software during a one-year rollout period.
EMR deployment was a business decision for MPMG as costs continue to escalate and payers were putting pressure on the group to be more efficient. It was obvious to the MPMG board of directors and to the MPMG EMR Committee that few practices would move forward without significant financial support up front. The lure of future government dollars did not figure into past or future IPA calculations, since requirements for government reimbursement are nebulous at this time and were not extant during the planning stages. Significant financial support was afforded practices to relieve the burden of hardware and software costs, training, implementation, and data conversion. A temporary drop in revenue was also somewhat ameliorated with the financial support given. The IPA’s goal was to encourage EMR adoption for more efficient, better patient management at lower cost.
Take Home #1: Be sure to use all local resources before deciding which system to purchase or lease. Check with colleagues to see what works best in your type of practice and specialty. Use companies that have strong financials, good support, and that will be around in the next several years. Finally, see if your hospital or medical group is sponsoring specific EMRs, is providing monetary support, or can lighten the burden for your practice in any way. Do not go it alone.
The MPMG board decided that any government funds that might materialize should be retained by the physicians who have adopted EMR as a reward for early adoption. This act also served as a statement that the board believed adoption is the right thing to do for countless reasons — the promise of government funding not being of great import. At press time, the Center for Medicare and Medicaid Services (CMS) has not released “meaningful use” guidelines. These guidelines are to provide a list of EMR functions that must be met in order to receive government support. Many who follow this issue closely believe that one of the requirements for meaningful use will include the ability to share data with colleagues and other entities such as hospitals and laboratories.
There are many companies in the marketplace guaranteeing that they will be able to meet all meaningful use requirements. The requirements have not been finalized, so this claim is specious at best today. One other caveat is that the expense to achieve meaningful use with any one product may be cost-prohibitive. Many communities, including San Diego, are forming health information exchanges to facilitate data sharing among various healthcare entities. Be sure your EMR can participate in these collaborative ventures or else your practice may be electronic but unable to communicate with your colleagues and affiliated hospitals.
Take Home #2: The hurdles to obtain government dollars might be very high. Cast a wary eye on any company that “guarantees” meaningful use, as the costs to meet the requirements may be onerous. Look to the community for a health information exchange (HIE), which will allow your EMR to interface with the greater healthcare community at a reasonable cost, or one that lets you adopt electronic capabilities in a modular, affordable approach.
“Initial deployment in the office will be disruptive to you, your staff, and patients,” says Billie Green, MD, an adopter of MPMG’s EMR system. “I was pulling my hair out the first two weeks. Things have become much better. I’m already back to seeing the same number of patients that I saw before putting EMR in my office only after four weeks.” Dr. Green’s experience is typical of the physicians who deployed the MPMG-sponsored EMR. A four-month-lead time was required. Each office was shepherded by an EMR consultant who had experience in setting up more than 250 electronic offices, making the process less daunting for the physicians and office staff.
Take Home #3: Your vendor should be able to provide a consultant to assist with planning. Expect a large lead-time from completing a contract to deployment of your chosen system. A well-thought-out plan is necessary to ensure a successful experience. Remember, there are a limited number of healthcare IT specialists in a time when thousands of physicians are planning to go electronic. Plan accordingly.
Lucy Polak, MD, another adopter of MPMG’s EMR, has many observations about her deployment experience. “At first, our office could not see as many patients,” she says. “Our computer skills eventually improved. Patients are very impressed with electronic records and have been very supportive. It is much easier to evaluate a patient with all of the data in once place. I can also look at laboratory results, document my interpretation, and phone the patient very efficiently. Internal office communications are also much better as they are now more efficient and task assignment can be audited. I’m sorry to say we may not need as large an office staff going forward.”
Take Home #4: If you are deploying an EMR in the office, be ready for major changes. Workflow changes will be enormous. Things will be difficult at first but improve with time as long as there is commitment on the part of the staff and physicians. No transition from paper to computer was easy or without challenges for MPMG physicians. With perseverance, all have made the transition and are now practicing with electronic offices.
The electronic medical office has been slow in coming considering the rate of IT adoption across a range of industries over the past 20 years. The importance government and private payers are placing on electronic initiatives is very obvious considering the large amount of money committed. Where this becomes especially pertinent to the practicing physician is the future reduction in funding for medical care. Physicians hopefully can harness IT effectively, provide more cost-effective care, and, maybe, just maybe, see reimbursement keep up with the costs of keeping their practices open. We at MPMG made a choice to proceed with EMR. We hope you’ll join us.