EHR: Dr. Justin Graham's EHR Story from the 2012 HIMSS Conference

Uploaded by CMSHHSgov on 29.05.2012

I'm an infectious-disease specialist
in Northern California, and I'm
the Chief Medical Information Officer for NorthBay Healthcare,
an integrated delivery network
of community hospital and primary care clinics
in Northern California, about halfway
between San Francisco and Sacramento.
We had made a heavy investment
in our electronic health record system,
beginning in 2003, had already implemented
computerized provider order entry, CPOE, in 2009,
before the Stage One Meaningful Use standards were available.
We were already making a substantial investment
in using electronic health records
to improve the quality of care to our patients
and to improve the efficiency of our enterprise.
So it was natural to just go the extra effort
to get recognized financially by the federal government.
Surprisingly, it was -- there was some more work to be done
than where we had done.
For us, CPOE was already finished.
That was pretty easy -- we met that before we even started.
But there were a number of requirements
that required careful consideration and collaboration
among many stakeholders -- not just physicians, but nurses,
administrative personnel, revenue cycle management,
HIM professionals.
For instance, the requirement
to give a discharge summary to the patient in electronic form,
or release of records to the patient --
in electronic form, a care summary
when they departed the hospital, in electronic form --
those are things we had never contemplated before.
We had to come up with some new strategies
about how to deliver that to the patients.
We've only achieved Meaningful Use
and attested in an inpatient setting.
We have an outpatient deployment of our electronic health record
with our primary care clinics.
We are planning to attest in that domain, as well,
but we have some work ahead of us, some challenges
on the quality metrics and some challenges
around getting e-prescribing up and running.
I think one of the key things that any organization has to do
is, before they even go down this path,
is have appropriate governance in place.
And it doesn't matter if you're the smallest physician office
or if you're a hospital.
You need to have the right people sitting at the table
who are decision makers, and they have to be
both clinicians and administrative and I.T.,
who can sit and make decisions
about the finite pool of resources
that your organization has
and how they're going to be dedicated
to achieving this goal
and to be able to make decisions.
We had to make trade-offs
as we decided to pursue Meaningful Use.
We thought it was worth while as an organization
to do these things, but it meant other projects
that were also important to us
had to be put aside or put on the back burner.
And it was best for those decisions
to be made collaboratively by all the stakeholders
at an appropriate level of shared governance.
Once you have that shared governance,
then those providers can then --
the shared governance can then begin
to make a decision around how to best use
the internal resources of the organization --
that includes both money and human resources --
and how they can be devoted to doing
the work that they need to do.
My best advice to a small practice
that's just getting started would be
to think -- start with the vision.
Start with the vision of where you want your practice to be
and why you're doing it.
I think the best advice I heard about Meaningful Use
was from one of my colleagues, who said,
"You don't go have children just to get the tax write-off."
And in the same way, you shouldn't just put in an EHR
just to benefit financially from it.
That trade-off is not going to be in favor of pure money.
Implementing an EHR is really the beginning.
It's the beginning of the transformation
of how you deliver care in your practice.
And it's the starting gun.
Because once you have that fabulous tool in place,
there are many, many things you can do to drive better care
and to make your life more efficient.
But if you've just put in that EHR
and then you say, "I'm done -- on to the next project,"
then you'll forever be mired in those initial inefficiencies
and those initial decisions you made before you understood
the consequences of implementing the EHR.
You have to -- it's the same thing we do in all parts
of medicine, we should be doing, is plan, do, study, act.
Keep doing iterative refinements
and cycles of improvements using the EHR,
and eventually you'll get to a much better place.
I think patients eventually are going to have to get
more engaged in their health care.
Today, we see a growing movement of participatory medicine
and more patients getting involved.
It hasn't spread widely yet, although in the Bay Area,
we have a lot of very savvy health care consumers.
Eventually, it's nice that
one channel of the Meaningful Use requirements
is specifically around patient engagement
and allowing them to get
electronic copies of their health record
and encouraging organizations like ours
to think about patient portals and ways for patients
to communicate with their physicians.
I know that's not specific to Meaningful Use,
but that's the direction Meaningful Use is headed.
I think we've had a change in the conversation
the last few years from, "Is it worth it for me
to implement electronic health records?"
to, "How can I now use these tools?"
And this is the direction that the whole country is going.
We're no longer talking about the brave early adopters.
We're now talking about the masses actually talking about
implementing electronic health records.
And that's great, because then we can elevate the conversation,
because implementing electronic health records
is the starting line, it's the beginning.