Why a Bit of Change Can Be a Good Thing…

Let’s face it, change can be tough. It can be tough for patients and can certainly be tough for
the doctors and staff who take care of them. Two years ago, while sitting in a quarterly medical
staff meeting at Mission hospital, I remember the chief of staff (at the time) proclaiming, “if
you are a physician, and don’t like change, you need to get out of medicine”. How right he was.
When you look upon the healthcare landscape today, perhaps the words of legendary folk
singer Bob Dylan say it best: “the times they are a changin’…. ”.

In recent years, medical practices have been inundated with the proverbial “alphabet soup” of
directives reflecting the vast change in how medicine is practiced today. EHR (Electronic Health
Record), MU (Meaningful Use), PCMH (Patient Centered Medical Home), ACO (Accountable
Care Organization), PQRS (Physician Quality Reporting System), P4P (Pay for Performance) and
so many more phrases basically tell the story of “change” in modern healthcare delivery.

Today if doctors want to keep up with current healthcare delivery trends, provide the care their
patients expect from them, and in some cases get paid fairly, they must not only keep up on
their medicine knowledge, but must also keep up on their “practice management” acumen.
Only in this way will doctors be able to guarantee that they are able to care for their patients in
a cost-effective, quality-controlled and safe environment.

What I hope to do in the coming few blogs is talk about each of these “directives” from
my perspective (which is likely similar to the perspective of many of my colleagues). More
importantly for you though, I hope to share insights into how the adoption of such changes will
improve your patient experience at Our Family Doctor, and ultimately improve the quality of
your care as well.

The most obvious place to start this series is with the “EHR” (Electronic Health Record). Some
of those who will read this blog will likely wonder “what ever happened to the good ole’ EMR
(Electronic Medical Record)?” What’s the difference? A good way to remember the difference
between these two terms is that an EMR is a database for patient information – Period. An EHR
on the other hand, is a patient database where one can run reports and track quality measures.
An “EMR on steroids” if you will. Furthermore, an EHR is able to interface with hospitals and
other ancillary care vendors in meaningful ways sharing valuable health information.

An EHR system is particularly useful if physicians, or the third parties that compensate these
physicians, want to track the quality measures mentioned above. This focus on quality is pretty
much where medicine is heading – or more accurately, where medicine is today in our country.
Ok, so what exactly is a quality measure? I thought you’d never ask. Suppose you want to see
how often you ask adult patients if they smoke cigarettes, and better yet, how often those

who respond with a “yes” are then encouraged by their physician to quit smoking during that
same visit. With an EHR, a physician, or somebody on staff can track this kind of information.
Knowing this kind of data can improve care both at the individual level, and at the community
level – ideally leading to more positive outcomes (in this case patients quitting smoking).

Suppose you want to find out who among your patient panel of 2000-2500 patients are due for
their screening colonoscopy, mammogram or pap smear. Or, suppose you want to make sure
your diabetic patients have had their Hemoglobin A1c lab tests checked every 3-6 months to
better monitor their diabetes. These are the types of internal “queries” that a good EHR can
run helping physicians deliver better care to those who have entrusted them to do just that.

An EHR also allows physicians to provide more efficient care for their patients by having all
of the information pertaining to that patient in one place. No more thumbing through thick
charts looking for paper records that are misfiled, or hunting down faxes and lab results. With a
properly functioning EHR, all of the relevant patient data is right there in the electronic record –
a few clicks away.

Oh, and let’s not forget the handwriting issue. Certainly it is common knowledge that
physicians have terrible penmanship – well, at least 98.7% of them do. Toward the end of my
paper chart career, I swear I could not even read my own hand writing – how frustrating, and
well.., embarrassing. With our new EHR our progress notes and other correspondences are not
only legible, but time and date stamped and categorized intelligently.

So, now that you know the benefits of EHR technology for both patients and their health care
providers, you may wonder why haven’t all doctors already adopted this technology? Two
reasons: it’s expensive, and it is a really big change. Well, a few years ago, in a bi-partisan
manner, our federal government realizing that the EHR adoption process needed to move along
more quickly, voted to subsidize doctors who took this financial plunge. With the passage of
the HITECH act, physicians who adopted an EHR in their offices could now qualify for a subsidy
to offset the costs. The hope of increasing EHR adoption from around 40% of doctors nationally
just a few years ago to closer to 100%, may now be a possibility (though we do have a long
way to go still). Naturally, there are very big strings attached to this subsidy (namely “MU”
or “meaningful use”) – but that will be the subject of my next blog.

For now however, and with this greater understanding of EHR, we ask that you continue to be
patient with the physicians and staff at Our Family Doctor as we continue to master the ins and
outs of our new EHR which we have purchased and are adopting.