PLAINVILLE FAMILY MEDICINE

When Jen Brull, a solo family physician, acquired her eMDs electronic health record system in 2007, she didn’t know how much it could do and how much time it would save her. But now she’s able to see an extra patient per hour and, with prompts from eMDs, she also provides better preventive and chronic care to her patients than she formerly did. As a result she has also significantly increased her income. And in April 2011, she became the first physician in Kansas to attest successfully to Meaningful Use of an EHR. Dr. Brull was also featured by CMS in a national meaningful use campaign.

Dr. Brull started practicing in rural Plainville, Kansas, in 2002, sharing space with two other primary care doctors who all were financially independent of each other. The providers in the practice - which now includes five physicians and three midlevel practitioners - also shared staff and other resources.

Dr. Brull had used an EHR in residency, and she knew that it was the wave of the future. But after she decided she wanted the group to have an EHR, she says, “Because we have such a unique practice structure, it took about three years for us to pick one out, come to a consensus, and decide how we were going to pay for it. ”

After narrowing down the choices and making site visits, Dr. Brull recalls, “We felt eMDs was the right one for us. It fit our price range and our criteria. For instance, everything had to live in one database. We didn’t want a modular system with the practice management software and the electronic chart separate. Pretty much everybody, from providers to staff, really liked the way eMDs fit us. It felt flexible, and it was affordable.”

eMDs’ flexibility has impressed Dr. Brull even more since she starting using it.

It’s so easy to customize a template, she says, that she once did it in the middle of a lecture to medical students on a new asthma guideline. And the EHR is so intuitive to use, she notes, that when med students rotate through the practice, they pick it up in less than a day.

EHR PROMPTS ARE KEY TO IMPROVEMENT

The biggest plus of eMDs, Dr. Brull says, is the difference it has made in the quality of care that she provides her patients. “What I love most about eMDs is that it has given me the ability to measure my quality and improve it.”

For example, she notes, she was screening only 30 percent of her eligible patients for colorectal cancer when she got eMDs; now she screens 90 percent. Similarly, her mammogram rate has jumped from 65 percent to 99 percent. She attributes much of the change to the health maintenance alerts that pop up whenever she opens a patient’s chart. Dr. Brull’s practice easily exceeds national averages for clinical benchmarks.

“I couldn’t have improved the process if I did not have an EHR that puts the reminders in front of my nose every time I open a chart. I know which patients I need to reach out to and I know which ones need services. In my office, if you are 50 or over, even if you come in for a cold, you’re also going to get talked to about colon cancer screening.”

EFFICIENCY AND ROI

Before she had an EHR, Brull says, she wasn’t frustrated with paper charts. She had everything neatly organized in her records, and she’d also designed her own paper based templates to facilitate documentation.

“But when I look back now, there were so many things we did that were crazy. How much time and effort we wasted doing things in a paper world that we can do with a click of a button in an electronic world!”

On average, Brull now cares for 28 patients per day, up from 20 before eMDs. Moreover, because she’s providing more comprehensive care, her revenue from each visit has jumped from $90 to $150, on average. “My dollars per patient are much higher, because we remember to give the tetanus, flu and pneumovax shots, and we remember to do microalbumens on all our diabetics, which we do in-house. All of that stuff adds up.”

Brull has noticed that all of her colleagues are seeing more patients than they used to. And because the practice is so efficient, the staff numbers less than two FTEs per provider. Even though all of the physicians in the group operate independently, since they are all using eMDs on a common database, they are able to support each other on call with complete access to patient data.

The return on investment in eMDs has been so good, Brull adds, that the group paid off its five-year loan on the EHR in two years. Meanwhile, she and her colleagues are receiving an even greater payback through Meaningful Use.

ACHIEVING MEANINGFUL USE

As soon as the Stage 1 Meaningful Use criteria were announced in 2010, Brull decided she was going to meet them as soon as possible and enlisted eMDs’ help.

“I’ve always had a great relationship with eMDs,” she says. “One of the best things about them is they are so reachable and approachable. I e-mailed their staff and got the inside track on where the company was going and what workflow modifications they were planning. So I knew ahead of time what I’d have to do, and what we could work on right away.”

Meanwhile, Brull enrolled in Kansas’ Health IT Regional Extension Center (REC) program, which is run by the Kansas Foundation for Medical Care. The REC made a valuable contribution, she says, by “clarifying some of the details of Meaningful Use.” They also helped the practice do a security analysis and remedy its deficiencies in that area. “They told us, ‘These are the things you need to correct; these are the policies you need to have in place.’”

Brull told eMDs that she wanted its upgraded version to be installed before Jan. 1, 2011, so she could start the 90-day period required to attest to Meaningful Use. eMDs came through during Christmas week. By the beginning of April, Brull was ready to attest, and a few weeks later, was the first physician in Kansas and in the first batch nationwide to receive an $18,000 Medicare incentive payment.

LEADING TO THE FUTURE

With a solid EHR infrastructure in place, Dr. Brull and her colleagues are leading in other ways too. A collaborative relationship with their local hospital has helped improve patient care and communication and formed the basis for a health information exchange. Plans for transitioning to a Patient-Centered Medical Home are under way. Dr. Brull also participates in several payer quality projects.

Overall, what impresses Brull most about eMDs “is the ability to have tremendous amounts of data at my fingertips, whether it’s for practice management or quality improvement. Other EHRs have that capability too, but what I like about eMDs is that it’s so flexible. It’s very easy to customize and make it do what you want it to.”

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